Provider Demographics
NPI:1538153069
Name:LEXINGTON RICHLAND ALCOHOL & DRUG ABUSE COUNCIL, INC.
Entity type:Organization
Organization Name:LEXINGTON RICHLAND ALCOHOL & DRUG ABUSE COUNCIL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:803-726-9301
Mailing Address - Street 1:PO BOX 50597
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-0597
Mailing Address - Country:US
Mailing Address - Phone:803-726-9301
Mailing Address - Fax:803-726-9480
Practice Address - Street 1:2711 COLONIAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-726-9301
Practice Address - Fax:803-726-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WG0000X, 291U00000X, 324500000X
SC261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD09LRMedicaid
SCAD09LRMedicaid