Organization
SC DEPARTMENT OF JUVENILE JUSTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JAN GIESEN LISW-CP AP (DIRECTOR OF SOCIAL WORK)
(803) 582-9337
Entity
Organization
Contact information
Practice address
5000 BROAD RIVER RD, COLUMBIA, SC 29212-3532
(803) 896-8694
Mailing address
5000 BROAD RIVER RD, COLUMBIA, SC 29210
(803) 896-8694
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
4938
SC
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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