Provider Demographics
NPI:1154780781
Name:BEAUFORT COUNTY ALCOHOL AND DRUG ABUSE DEPARTMENT
Entity type:Organization
Organization Name:BEAUFORT COUNTY ALCOHOL AND DRUG ABUSE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABISE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN-GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-255-6007
Mailing Address - Street 1:1905 DUKE ST
Mailing Address - Street 2:PO BOX 311
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6007
Mailing Address - Fax:
Practice Address - Street 1:1905 DUKE ST
Practice Address - Street 2:STE 270
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4403
Practice Address - Country:US
Practice Address - Phone:843-255-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD21BEMedicaid