Healthcare Provider Details

I. General information

NPI: 1821692245
Provider Name (Legal Business Name): EBONY DOWDELL PETERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

IV. Provider business mailing address

SC HOUSE CALLS INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax: 678-538-9613
Mailing address:
  • Phone: 800-491-0909
  • Fax: 678-538-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26463-C
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007391
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW4121
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW007391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: