Provider Demographics
NPI:1144637554
Name:SC DEPARTMENT OF HEALTH AND ENVIRMENTAL CONTROL
Entity type:Organization
Organization Name:SC DEPARTMENT OF HEALTH AND ENVIRMENTAL CONTROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:BOOTH
Authorized Official - Last Name:PITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:803-785-6639
Mailing Address - Street 1:1070 S LAKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-3701
Mailing Address - Country:US
Mailing Address - Phone:803-785-6671
Mailing Address - Fax:803-785-6556
Practice Address - Street 1:1070 S LAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-3701
Practice Address - Country:US
Practice Address - Phone:803-785-6671
Practice Address - Fax:803-785-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local