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77 Hazzard Creek Vlg Ste C Ridgeland SC 29936-8266 | |
| (843) 645-7700 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 77 Hazzard Creek Vlg Ste C, Ridgeland, South Carolina |
| Authorized Official Name and Position | Christina Ryan (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 3373455110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
101 Feu Follet Rd Ste 100 Lafayette LA 70508-4234 Ph: (337) 345-5110 | 77 Hazzard Creek Vlg Ste C Ridgeland SC 29936-8266 Ph: (843) 645-7700 |
| NPI Number | 1629361217 |
|---|---|
| Provider Enumeration Date | 05/16/2011 |
| Last Update Date | 05/14/2024 |
| Certification Date | 05/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629361217 | NPI | - | NPPES |
| 147BHS | Medicaid | SC | |
| GP6066 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTP-0111 (South Carolina) | Primary |
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