| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 124 Wylie St, Chester, South Carolina |
| Authorized Official Name and Position | Margaret Barber (AGENCY DIRECTOR) |
| Authorized Official Contact | 8038965940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 21069 Columbia SC 29221-1069 Ph: () - | 124 Wylie St Chester SC 29706-1792 Ph: (803) 377-8104 |
| NPI Number | 1851644207 |
|---|---|
| Provider Enumeration Date | 10/23/2012 |
| Last Update Date | 10/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851644207 | NPI | - | NPPES |
| DJJ012 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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