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403 Stoney Landing Rd Moncks Corner SC 29461-3967 | |
| (843) 761-8282 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 403 Stoney Landing Rd, Moncks Corner, South Carolina |
| Authorized Official Name and Position | Tracy L Turner (CONTROLLER) |
| Authorized Official Contact | 8038988503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
403 Stoney Landing Rd Moncks Corner SC 29461-3967 Ph: (843) 761-8282 | 403 Stoney Landing Rd Moncks Corner SC 29461-3967 Ph: (843) 761-8282 |
| NPI Number | 1508811324 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 09/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508811324 | NPI | - | NPPES |
| 435201 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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