Healthcare Provider Details

I. General information

NPI: 1467173740
Provider Name (Legal Business Name): MEAGAN LINDSEY BRODER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 ELMWOOD AVE STE 300B
COLUMBIA SC
29201-2150
US

IV. Provider business mailing address

3012 LINCOLN ST
COLUMBIA SC
29201-1518
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-5109
  • Fax: 803-369-7100
Mailing address:
  • Phone: 615-678-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17494
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: