Provider Demographics
NPI:1902104276
Name:MINDS MOVING FORWARD
Entity Type:Organization
Organization Name:MINDS MOVING FORWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-308-2954
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1629
Mailing Address - Country:US
Mailing Address - Phone:803-308-2954
Mailing Address - Fax:
Practice Address - Street 1:1314 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-7635
Practice Address - Country:US
Practice Address - Phone:803-308-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
SC251S00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle