Healthcare Provider Details

I. General information

NPI: 1215045190
Provider Name (Legal Business Name): ANGELA MARIA GROCE LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MARIA MCEACHERN LCSW

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 PENDLETON ST A207
COLUMBIA SC
29201-3836
US

IV. Provider business mailing address

210 CHESTNUT WREN RD
BLYTHEWOOD SC
29016
US

V. Phone/Fax

Practice location:
  • Phone: 803-705-5156
  • Fax: 803-705-5690
Mailing address:
  • Phone: 803-606-3685
  • Fax: 803-705-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8423
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: