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General NPI Number Information
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NPI Number | 1760532022
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Entity Type | Individual
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Provider Name | KIM M MAUTZ CHARPIA MSW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 202 SALISBURY DR.
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-851-5824
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Fax | 843-851-7560
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Provider Business Mailing Address
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Address Line | 202 SALISBURY DR
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City | SUMMERVILLE
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State | SC
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Zip | 29483-4345
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Country | US
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Telephone | 843-851-5824
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Fax | 843-851-7560
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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 | 1883
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 68
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License Number State | SC
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