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General NPI Number Information
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NPI Number | 1780745455
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Entity Type | Organization
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Legal Business Name | TRINITY BEHAVIORAL CARE - MARION OFFICE
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 1305 N MAIN ST
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City | MARION
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State | SC
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Zip | 29571-2010
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Country | US
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Telephone | 843-423-8292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1011
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City | MARION
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State | SC
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Zip | 29571-1011
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Country | US
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Telephone | 843-423-8292
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Fax | 843-423-8294
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONNY BROCK
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Credential |
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Telephone | 843-423-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | OTP-004
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | OTP-004
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License Number State | SC
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