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General NPI Number Information
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NPI Number | 1316274228
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Entity Type | Organization
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Legal Business Name | LRC FOR SUBSTANCE ABUSE & BEHAVIORAL PROBS.
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 1105 BELLEVIEW ST.
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City | COLUMBIA
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State | SC
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Zip | 29202
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Country | US
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Telephone | 803-740-9298
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Fax | 803-223-9420
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Provider Business Mailing Address
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Address Line | PO BOX 8724 1105 BELLEVIEW ST.
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City | COLUMBIA
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State | SC
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Zip | 29202
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Country | US
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Telephone | 803-740-9298
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Fax | 803-223-9420
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Authorized Official
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Title or Position | OWNER
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Name | MR. HENRY P. MCFADDEN
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Credential |
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Telephone | 803-740-9298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | OPT-0097
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | OPT-0097
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License Number State | SC
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