Healthcare Provider Details

I. General information

NPI: 1508005257
Provider Name (Legal Business Name): RODNEY OLANDIS WHITE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 LAKESHORE PKWY SUITE 105
ROCK HILL SC
29730-4291
US

IV. Provider business mailing address

452 LAKESHORE PKWY SUITE 105
ROCK HILL SC
29730-4291
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1915
  • Fax: 803-329-1918
Mailing address:
  • Phone: 803-329-1915
  • Fax: 803-329-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8653
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: