=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497817613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY BEHAVIORAL CARE - MARLBORO OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 N. MARLBORO ST.
-----------------------------------------------------
City | BENNETTSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29512-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-479-5683
-----------------------------------------------------
Fax | 843-479-5685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1053
-----------------------------------------------------
City | BENNETTSVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29512-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-479-5683
-----------------------------------------------------
Fax | 843-479-5685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. WILLIAM T. O'CONNOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-423-8292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | OTP-004
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | OTP-004
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------