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General NPI Number Information
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NPI Number | 1780915983
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Entity Type | Individual
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Provider Name | GWENDOLYN SPANN SHORTER LISW, CP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 430 ALBERT ST 410 CEDAR LN.
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City | BISHOPVILLE
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State | SC
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Zip | 29010-1202
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Country | US
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Telephone | 443-857-1248
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Fax | 803-843-1410
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Provider Business Mailing Address
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Address Line | 430 ALBERT ST PO BOX 282
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City | BISHOPVILLE
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State | SC
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Zip | 29010-1202
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Country | US
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Telephone | 443-857-1248
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Fax | 803-483-1410
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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 | 9089
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License Number State | SC
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