Healthcare Provider Details

I. General information

NPI: 1053749176
Provider Name (Legal Business Name): THANDI BLANDING LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 CAMDEN HWY
DALZELL SC
29040-9336
US

IV. Provider business mailing address

4565 CAMDEN HWY
DALZELL SC
29040-9336
US

V. Phone/Fax

Practice location:
  • Phone: 803-607-5024
  • Fax:
Mailing address:
  • Phone: 803-607-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9771
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: