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General NPI Number Information
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NPI Number | 1780865378
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Entity Type | Organization
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Legal Business Name | MILITARY SPOUSAL SUPPORT CENTER
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Dates
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Enumeration Date | 11/24/2007
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Last Update Date | 11/24/2007
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Provider Practice Location Address
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Address Line | 410 OAKLAND AVE
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City | ROCK HILL
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State | SC
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Zip | 29730-3530
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Country | US
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Telephone | 803-324-1976
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Fax | 803-324-4578
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Provider Business Mailing Address
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Address Line | 410 OAKLAND AVE
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City | ROCK HILL
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State | SC
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Zip | 29730-3530
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Country | US
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Telephone | 803-324-1976
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Fax | 803-324-4578
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHIRLEY KING MILLER
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Credential |
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Telephone | 803-324-1976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSM1561
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License Number State | SC
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