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Contact Information

SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
100 EXECUTIVE CENTER DR
SANTEE BUILDING SUITE210
COLUMBIA, SC29210-8407
 Phone: 803-896-4751
 Fax: 803-896-8473
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE

NPI # 1528108073
LBN Legal business name SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Authorized official MIA RICHARDSON - (MEDICAID PROJECT ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 02/07/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
SC Medicaid 969MXH
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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