Organization
DEPARTMENT OF MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SADATREYA TANESHA MOULTRIE (TRANSITION SPECIALIST)
(912) 536-6454
Entity
Organization
Contact information
Practice address
2414 BULL ST, COLUMBIA, SC 29201-1906
(803) 898-8581
Mailing address
436 CORAL ROSE DR, IRMO, SC 29063-7503
(912) 536-6454
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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