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NPI Code Detail

MEDICARE: MRS. LAUREN MCCLINTOCK LESLIE LISW-CP

MEDICARE:  MRS. LAUREN MCCLINTOCK LESLIE  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
11041C0700XClinical Social Worker14105SC

General Provider Information

NPI Number : 1598340531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN MCCLINTOCK LESLIE LISW-CP
Provider Business Mailing Address
First Line : 582 VILLAGE CHURCH DR
Second Line :
City : CHAPIN
State : SC
Zip : 29036-7538
Country : US
Telephone Number : 803-298-4376
Fax Number :
Provider Business Practice Location Address
First Line : 1180 COLUMBIA AVE STE 203
Second Line :
City : IRMO
State : SC
Zip : 29063-2890
Country : US
Telephone Number : 407-803-0088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 03/11/2021

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Directions to “ MRS. LAUREN MCCLINTOCK LESLIE LISW-CP” Practice Location

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