| Season 4 Change, Llc | |
|
3524 Jefferson Davis Hwy Graniteville SC 29829-9998 | |
| (803) 380-9004 | |
| Not Available |
| Full Name | Season 4 Change, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3524 Jefferson Davis Hwy, Graniteville, South Carolina |
| Authorized Official Name and Position | Darrell William Jones (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9125082582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Season 4 Change, Llc 139 Barnard Ave Se Aiken SC 29801-7203 Ph: (912) 508-2582 | Season 4 Change, Llc 3524 Jefferson Davis Hwy Graniteville SC 29829-9998 Ph: (803) 380-9004 |
| NPI Number | 1578126181 |
|---|---|
| Provider Enumeration Date | 04/18/2019 |
| Last Update Date | 12/06/2019 |
| Medicare PECOS PAC ID | 2567898729 |
|---|---|
| Medicare Enrollment ID | O20200206000973 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578126181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Darrell William Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205994886 PECOS PAC ID: 7214197250 Enrollment ID: I20200206001136 |
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