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COLLETON COMMISSION ON ALCOHOL AND DRUG ABUSE

Addiction Substance Use Disorder

Walterboro, South Carolina

Provider NPI: 1962400325

Organization Information:
Organization Name:  COLLETON COMMISSION ON ALCOHOL AND DRUG ABUSE
Organization is not Subpart
Authorized Official:  RONALD L. RICKENBAKER  DIRECTOR  843-5384343

Practice Location:
1439 THUNDERBOLT DR  WALTERBORO, SC 29488 US
Tel: 843-538-4343  Fax: 843-538-7613

Business Mailing Address:
PO BOX 1037  WALTERBORO, SC 29488 US
Tel: 843-538-4343  Fax: 843-538-7613

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
X251S00000XAgencies
Community/Behavioral Health

Other Provider Identifiers:

IssuerNumberStateType
AD33CLSC05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS SC - Page 1



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