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General NPI Number Information
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NPI Number | 1205065828
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Entity Type | Organization
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Legal Business Name | BERKELEY COMMUNITY MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 403 STONEY LANDING RD
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3967
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Country | US
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Telephone | 843-761-8282
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Fax | 843-761-7308
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Provider Business Mailing Address
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Address Line | 7863 LONG SHADOW LN
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 843-761-8282
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Fax | 843-761-7308
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Authorized Official
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Title or Position | ADVANCED PRACTICE REGISTERED NURSE
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Name | MRS. STANTRENETTA AKEYA HARROLD
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Credential | APRN
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Telephone | 843-761-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 3810
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License Number State | SC
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