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General NPI Number Information
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NPI Number | 1730096355
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Entity Type | Individual
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Provider Name | KARLA DE LEON MENDEZ
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Gender |
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 40 BALDWIN AVE
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City | LUGOFF
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State | SC
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Zip | 29078-9406
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Country | US
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Telephone | 803-438-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 BROAD ST STE 3D
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City | CAMDEN
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State | SC
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Zip | 29020-3610
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19184
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License Number State | SC
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