Organization
MINDS MOVING FORWARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMAR GILLIARD (DIRECTOR OF OFFICE)
(803) 308-2954
Entity
Organization
Contact information
Practice address
1314 CHEROKEE ST, ORANGEBURG, SC 29115-7635
(803) 308-2954
Mailing address
PO BOX 1629, ORANGEBURG, SC 29116-1629
(803) 308-2954
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
SC
347C00000X
Private Vehicle
—
SC
Other
Enumeration date
03/10/2011
Last updated
03/10/2011
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