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General NPI Number Information
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NPI Number | 1790935336
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Entity Type | Organization
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Legal Business Name | CENTER FOR PERSONAL GROWTH
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 150 B W THOMAS DR #125
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City | FT. MILL
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State | SC
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Zip | 29708
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Country | US
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Telephone | 803-517-9816
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Fax | 803-548-5343
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Provider Business Mailing Address
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Address Line | 150 B.W. THOMAS DRIVE #125
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City | FT. MILL
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State | SC
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Zip | 29708
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Country | US
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Telephone | 803-517-9816
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Fax | 803-548-5343
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SALLY A SMITH
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Credential | SOCIAL WORKER
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Telephone | 803-283-3810
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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 | 6244
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License Number State | SC
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