Basic Information
| Provider Information | |||||||||
| NPI: | 1306187984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AIKEN BARNWELL MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 W O EZELL BLVD APT I68 | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293011543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036413940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1135 GREGG HWY | ||||||||
| Address2: | |||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298016341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036417700 | ||||||||
| FaxNumber: | 8036417709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2013 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | GRIGSBY | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | HUMAN SERVICE COORDINATOR I | ||||||||
| AuthorizedOfficialTelephone: | 8036413940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.