Healthcare Provider Details

I. General information

NPI: 1902020431
Provider Name (Legal Business Name): MARLO ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLO A BALL LISW-CP

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

109 BEE ST
CHARLESTON SC
29401-5703
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-5011
  • Fax:
Mailing address:
  • Phone: 843-543-0916
  • Fax: 843-579-2724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6404
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: