Organization
NEW DOMINION COMMUNITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IDRIS TALIB (PRESIDENT)
(864) 847-1818
Entity
Organization
Contact information
Practice address
900 GREENVILLE DRIVE, WILLIAMSTON, SC 29697-0000
(864) 847-1818
(678) 550-9865
Mailing address
900 GREENVILLE DR, WILLIAMSTON, SC 29697-1130
(864) 847-1818
(678) 550-9865
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6646
—
SC
Enumeration date
10/21/2014
Last updated
11/20/2015
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