Provider Demographics
NPI:1316274228
Name:LRC FOR SUBSTANCE ABUSE & BEHAVIORAL PROBS.
Entity type:Organization
Organization Name:LRC FOR SUBSTANCE ABUSE & BEHAVIORAL PROBS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-740-9298
Mailing Address - Street 1:PO BOX 8724
Mailing Address - Street 2:1105 BELLEVIEW ST.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202
Mailing Address - Country:US
Mailing Address - Phone:803-740-9298
Mailing Address - Fax:803-223-9420
Practice Address - Street 1:1105 BELLEVIEW ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29202
Practice Address - Country:US
Practice Address - Phone:803-740-9298
Practice Address - Fax:803-223-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT-0097101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7000128742OtherQPL#