Healthcare Provider Details

I. General information

NPI: 1750998662
Provider Name (Legal Business Name): CAITLIN THAMES LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 HARDEN STREET EXT
COLUMBIA SC
29203-6894
US

IV. Provider business mailing address

3555 HARDEN STREET EXT
COLUMBIA SC
29203-6894
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1030
  • Fax: 803-434-1031
Mailing address:
  • Phone: 803-434-1030
  • Fax: 803-434-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17230
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: