Provider Demographics
NPI:1083432967
Name:LRC SUBSTANCE ABUSE AND BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:LRC SUBSTANCE ABUSE AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-713-5283
Mailing Address - Street 1:PO BOX 8724
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-8724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 BELLEVIEW ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1839
Practice Address - Country:US
Practice Address - Phone:803-740-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder