Provider Demographics
NPI:1043654965
Name:PEE DEE MENTAL HEALTH
Entity type:Organization
Organization Name:PEE DEE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANIKA
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:GEORGE-STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:843-332-4141
Mailing Address - Street 1:900 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5787
Mailing Address - Country:US
Mailing Address - Phone:843-332-4141
Mailing Address - Fax:843-383-4625
Practice Address - Street 1:900 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5787
Practice Address - Country:US
Practice Address - Phone:843-332-4141
Practice Address - Fax:843-383-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85061251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health