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General NPI Number Information
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NPI Number | 1831338961
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 2414 BULL ST ATTN: TDE GRANT OF TELEPSYCHIATRY
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City | COLUMBIA
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State | SC
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Zip | 29201-1906
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Country | US
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Telephone | 803-898-7183
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Fax | 803-898-8644
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Provider Business Mailing Address
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Address Line | 2414 BULL ST ATTN: TDE GRANT OF TELEPSYCHIATRY
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City | COLUMBIA
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State | SC
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Zip | 29201-1906
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Country | US
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Telephone | 803-898-7183
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Fax | 803-898-8644
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BRENDA RATLIFF
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Credential | M.D.
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Telephone | 803-898-7183
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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 |
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License Number State |
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