Healthcare Provider Details

I. General information

NPI: 1790028587
Provider Name (Legal Business Name): ALICIA CATOE EDDINS LISW-CP, CACI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 EAST BLVD
CHESTERFIELD SC
29709-5148
US

IV. Provider business mailing address

1218 EAST BLVD
CHESTERFIELD SC
29709-5148
US

V. Phone/Fax

Practice location:
  • Phone: 843-623-7062
  • Fax: 843-623-7112
Mailing address:
  • Phone: 843-623-7062
  • Fax: 843-623-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1308272
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9513
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: