Provider Demographics
NPI:1538227087
Name:ALSTON WILKES SOCIETY
Entity type:Organization
Organization Name:ALSTON WILKES SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:S.
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-2490
Mailing Address - Street 1:3519 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6504
Mailing Address - Country:US
Mailing Address - Phone:803-799-2490
Mailing Address - Fax:803-540-7223
Practice Address - Street 1:3519 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6504
Practice Address - Country:US
Practice Address - Phone:803-799-2490
Practice Address - Fax:803-540-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC900MXHMedicaid
SCCBT-014Medicaid
SC897MXHMedicaid
SC943MXHMedicaid