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General NPI Number Information
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NPI Number | 1417028374
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Entity Type | Organization
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Legal Business Name | CENTER OF CHANGE
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 2039 W DEKALB ST BUILDING 1, SUITE 2
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City | CAMDEN
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State | SC
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Zip | 29020-2092
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Country | US
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Telephone | 803-432-5200
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Fax | 803-432-5199
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Provider Business Mailing Address
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Address Line | 2039 W DEKALB ST BUILDING 1, SUITE 2
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City | CAMDEN
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State | SC
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Zip | 29020-2092
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Country | US
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Telephone | 803-432-5200
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Fax | 803-432-5199
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Authorized Official
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Title or Position | OWNER
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Name | MS. NANCY JENERETTE HORNSBY
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Credential | MS, LBSW
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Telephone | 803-432-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8724
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License Number State | SC
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