Healthcare Provider Details

I. General information

NPI: 1750532370
Provider Name (Legal Business Name): RONI L. CAW PHD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BELLEVIEW ST STE 103
COLUMBIA SC
29201-1839
US

IV. Provider business mailing address

1115 BELLEVIEW ST STE 103
COLUMBIA SC
29201-1839
US

V. Phone/Fax

Practice location:
  • Phone: 803-728-0497
  • Fax: 803-764-4028
Mailing address:
  • Phone: 803-728-0497
  • Fax: 803-764-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4960
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: