Healthcare Provider Details

I. General information

NPI: 1699908012
Provider Name (Legal Business Name): PAMELA S. WOOD LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 LEAPHART RD
WEST COLUMBIA SC
29169-3000
US

IV. Provider business mailing address

245 WOOD BRANCH LN
RIDGEWAY SC
29130-9368
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-0495
  • Fax: 803-791-1958
Mailing address:
  • Phone: 803-635-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6490
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: