Provider Demographics
NPI:1427422583
Name:SC DEPARTMENT OF JUVENILE JUSTICE
Entity type:Organization
Organization Name:SC DEPARTMENT OF JUVENILE JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST III
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:864-429-3610
Mailing Address - Street 1:1585 JONESVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-9790
Mailing Address - Country:US
Mailing Address - Phone:864-429-3610
Mailing Address - Fax:
Practice Address - Street 1:1585 JONESVILLE HWY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-9790
Practice Address - Country:US
Practice Address - Phone:864-429-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty