| South Carolina State Government | |
|
1725 Shivers Rd Columbia SC 29210-5413 | |
| (806) 896-5695 | |
| Not Available |
| Full Name | South Carolina State Government |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1725 Shivers Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Deborah Bennett-york (SOCIAL WORKER) |
| Authorized Official Contact | 8037888911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Carolina State Government 11 Bradford Knoll Ct Columbia SC 29223-7142 Ph: (803) 788-8911 | South Carolina State Government 1725 Shivers Rd Columbia SC 29210-5413 Ph: (806) 896-5695 |
| NPI Number | 1619212917 |
|---|---|
| Provider Enumeration Date | 11/28/2012 |
| Last Update Date | 12/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619212917 | NPI | - | NPPES |
| 29832 | Other | SC | AMERICAN BOARD OF EXAMINERS OF CLINICAL SOCIAL WORKERS |
| 4663 | Other | SC | LICENSED BY THE BOARD OF SOCIAL WORK EXAMINERS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4663 (South Carolina) | Primary |
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