Healthcare Provider Details

I. General information

NPI: 1639651961
Provider Name (Legal Business Name): LINDSEY TERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY WHIPPLE

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PALMETTO PK. BOULVEARD SUITE D
LEXINGTON SC
29072
US

IV. Provider business mailing address

107 PINEHAVEN WAY
SIMPSONVILLE SC
29680-7060
US

V. Phone/Fax

Practice location:
  • Phone: 803-996-1500
  • Fax:
Mailing address:
  • Phone: 801-471-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12703
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: