=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346840287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROMER COUNSELING, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2020
-----------------------------------------------------
Last Update Date | 10/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10415 BROAD RIVER RD UNIT J
-----------------------------------------------------
City | IRMO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29063-9686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-983-1749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 WOODHOUSE LOOP
-----------------------------------------------------
City | IRMO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29063-7781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-983-1749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MARIA IRINA CROMER
-----------------------------------------------------
Credential | LISW-CP
-----------------------------------------------------
Telephone | 803-983-1749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------