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General NPI Number Information
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NPI Number | 1427422583
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Entity Type | Organization
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Legal Business Name | SC DEPARTMENT OF JUVENILE JUSTICE
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1585 JONESVILLE HWY
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City | UNION
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State | SC
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Zip | 29379-9790
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Country | US
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Telephone | 864-429-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 1585 JONESVILLE HWY
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City | UNION
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State | SC
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Zip | 29379-9790
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Country | US
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Telephone | 864-429-3610
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST III
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Name | AMY HALL HANSEN
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Credential | MA
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Telephone | 864-429-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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