Healthcare Provider Details

I. General information

NPI: 1487839890
Provider Name (Legal Business Name): LINDA A THOMAS LISW CP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326-A MEDICAL PLAZA DR
CHARLESTON SC
29406
US

IV. Provider business mailing address

9326-A MEDICAL PLAZA DR
CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-377-1600
  • Fax: 843-377-1601
Mailing address:
  • Phone: 843-377-1600
  • Fax: 843-377-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5667LISWCP
License Number StateSC

VIII. Authorized Official

Name: MS. SANDRA H MATTHEWS
Title or Position: OWNER
Credential: HIPPA COMPLIANCE OFF
Phone: 843-408-4162