Healthcare Provider Details

I. General information

NPI: 1235539958
Provider Name (Legal Business Name): CAROLYN PAULINE PRIVETTE LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 BROWN MILL RD
PACOLET SC
29372-2805
US

IV. Provider business mailing address

438 BROWN MILL RD
PACOLET SC
29372-2805
US

V. Phone/Fax

Practice location:
  • Phone: 864-415-4184
  • Fax:
Mailing address:
  • Phone: 864-415-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18679
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: