Basic Information
| Provider Information | |||||||||
| NPI: | 1639411911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON COUNTY COMMUNITY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PALMETTO PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290727872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039961500 | ||||||||
| FaxNumber: | 8039961510 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 PALMETTO PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290727872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039961500 | ||||||||
| FaxNumber: | 8039961510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | WESTERLUND | ||||||||
| AuthorizedOfficialFirstName: | JUNE | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | QA COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8039961500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LISW-CP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 3000641104 | 01 | SC | WORKER'S COMP | OTHER | 322842 | 05 | SC | MEDICAID |