=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952689697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEDERATION OF FAMILIES OF SOUTH CAROLINA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2011
-----------------------------------------------------
Last Update Date | 07/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 DUTCH SQUARE BLVD SUITE 205
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-772-5210
-----------------------------------------------------
Fax | 803-772-5212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 DUTCH SQUARE BLVD SUITE 205
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-772-5210
-----------------------------------------------------
Fax | 803-772-5212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. DIANE REVELS FLASHNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-772-5210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------