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General NPI Number Information
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NPI Number | 1205175452
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Entity Type | Organization
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Legal Business Name | S.C DEPARTMENT OF JUVENILE JUSTICE
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 2112 CHANDLER AVE
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City | COLUMBIA
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State | SC
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Zip | 29210-6204
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Country | US
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Telephone | 803-896-9784
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 CHANDLER AVE
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City | COLUMBIA
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State | SC
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Zip | 29210-6204
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Country | US
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Telephone | 803-896-9784
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SOCIAL WORK
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Name | MRS. JAN GIESEN
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Credential | LIMSW
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Telephone | 803-896-4813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 3627
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License Number State | SC
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