Basic Information
| Provider Information | |||||||||
| NPI: | 1205065828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKELEY COMMUNITY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7863 LONG SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437618282 | ||||||||
| FaxNumber: | 8437617308 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 STONEY LANDING RD | ||||||||
| Address2: | |||||||||
| City: | MONCKS CORNER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294613967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437618282 | ||||||||
| FaxNumber: | 8437617308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARROLD | ||||||||
| AuthorizedOfficialFirstName: | STANTRENETTA | ||||||||
| AuthorizedOfficialMiddleName: | AKEYA | ||||||||
| AuthorizedOfficialTitleorPosition: | ADVANCED PRACTICE REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 8437618282 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 3810 | SC | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.