Healthcare Provider Details

I. General information

NPI: 1235045725
Provider Name (Legal Business Name): NICOLE BUIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FOREST DR STE 400
COLUMBIA SC
29204-4010
US

IV. Provider business mailing address

325 CRASSULA DR
LEXINGTON SC
29073-6880
US

V. Phone/Fax

Practice location:
  • Phone: 843-994-7696
  • Fax:
Mailing address:
  • Phone: 803-467-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16462
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: