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Organization
CHANNEL THE BEACON
Active
Organization
CHANNEL THE BEACON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTE S SIMMONS BS, MBA, DHA (EXECUTIVE DIRECTOR)
(843) 330-1522
Entity
Organization
Contact information
Practice address
6650 RIVERS AVE, SUITE 1408, NORTH CHARLESTON, SC 29406-4809
(843) 576-1408
(843) 278-9275
Mailing address
PO BOX 41294, NORTH CHARLESTON, SC 29423-1294
(843) 330-1522
(843) 278-9275
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
SC
251V00000X
Voluntary or Charitable Agency
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM1007
—
SC
Enumeration date
08/26/2013
Last updated
09/05/2014
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