Organization
COUNSELING AND INNOVATIVE TREATMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH JACKSON (CEO)
(803) 779-0169
Entity
Organization
Contact information
Practice address
2712 MIDDLEBURG DR, SUITE 206, COLUMBIA, SC 29204-2415
(803) 779-0169
Mailing address
2712 MIDDLEBURG DR, SUITE 206, COLUMBIA, SC 29204-2415
(803) 779-0169
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
5286
SC
Other
Enumeration date
09/30/2011
Last updated
10/31/2011
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