Healthcare Provider Details

I. General information

NPI: 1508262254
Provider Name (Legal Business Name): LENORA TALLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 HUMAN SERVICES RD
CLINTON SC
29325-7546
US

IV. Provider business mailing address

PO BOX 447
LAURENS SC
29360-0447
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-0000
  • Fax: 864-833-3600
Mailing address:
  • Phone: 864-833-0000
  • Fax: 864-833-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005760
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: