MEDICARE: SOUTHEAST CENTER FOR FAMILY DEVELOPMENT & INSTITUTE FOR FAMILY ENRICHM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1164976643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST CENTER FOR FAMILY DEVELOPMENT & INSTITUTE FOR FAMILY ENRICHM

Provider Business Mailing Address
First Line	:	6326 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6326 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3126
Country	:	US
Telephone Number	:	803-335-9975
Fax Number	:

Authorized Official
Title or Position	:	CENTER DIRECTOR
Name	:	MR. JOSEPH L MILLER
Credential	:	MSW
Telephone Number	:	803-335-9975

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	08/12/2016

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