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General NPI Number Information
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NPI Number | 1609780667
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Entity Type | Individual
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Provider Name | LISA AMANDA LONDONO
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Gender | Female
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 3935 SUNSET BLVD STE C
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-2403
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Country | US
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Telephone | 843-737-2934
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Fax |
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Provider Business Mailing Address
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Address Line | 902 BEAUFORT ST
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City | COLUMBIA
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State | SC
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Zip | 29201-1614
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Country | US
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Telephone | 843-737-2934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW.17643
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License Number State | SC
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