MEDICARE: MRS. GEORGETTE THOMASINA FUHR MSW, LCSW, LISW-CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C011055	NC
2	1041C0700X	Clinical Social Worker	13440	SC
3	101YM0800X	Mental Health Counselor	13440	SC

General Provider Information

NPI Number	:	1265855092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGETTE THOMASINA FUHR MSW, LCSW, LISW-CP

Provider Business Mailing Address
First Line	:	2424 INDIA HOOK RD STE 140
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	803-339-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD STE 140
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	803-339-9504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	12/10/2021

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