South Carolina Mentor

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1-13-12976 Issued in SC

Legal business name

SOUTH CAROLINA MENTOR

Practice address

4 Carriage LN
Suite 302
Charleston, SC 29407-6065

Phone

(843) 573-1905

Fax

(843) 573-1926

NPI assigned

Mar 26, 2013

Organization subpart

Yes

Parent organization

THE MENTOR NETWORKAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jennifer Mary Poole, BCBA

Title

Behavioral Consultant

Phone

(843) 513-0040

Specialties & licenses 2

Addresses

Tax ID family

South Carolina Mentor Inc3 organizations share this tax ID, including this one

Part of

South Carolina Mentor Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• South Carolina Mentor, Inc.

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1023832821
  NPD tax ID
• South Carolina Mentor, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Columbia, SC
  • NPI 1588823900
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1972845196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN",
            "address_2": "SUITE 302",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076065",
            "telephone_number": "843-573-1905",
            "fax_number": "843-573-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN",
            "address_2": "SUITE 302",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076065",
            "telephone_number": "843-573-1905",
            "fax_number": "843-573-1926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA MENTOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MENTOR NETWORK",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "BEHAVIORAL CONSULTANT",
        "authorized_official_telephone_number": "843-513-0040",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": "1-13-12976",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "SC",
            "license": "1-13-12976",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Carolina Dhec
• South Carolina Diagnostic Imaging, Inc
• South Carolina Diagnostic Imaging, LLC
• South Carolina Interventional Pain - C, LLC
• South Carolina Medical Specialists PC
• South Carolina Neuro, LLC
• South Carolina Women'S Center, LLC
• Roger A Southall, Jr, CRNA
• Colton Southard-Goebel, MD
• Bailey Southard, PHARMD

• Community/Behavioral Health Agency in Charleston, SC
• Providers in Charleston, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.