Healthcare Provider Details

I. General information

NPI: 1386993046
Provider Name (Legal Business Name): TANIEKA M WARD-AKABANE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2012
Last Update Date: 09/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SUMMER BROOK CT
BLYTHEWOOD SC
29016-9565
US

IV. Provider business mailing address

63 SUMMER BROOK CT
BLYTHEWOOD SC
29016-9565
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-6952
  • Fax:
Mailing address:
  • Phone: 803-754-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7214
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: