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General NPI Number Information
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NPI Number | 1841664125
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Entity Type | Individual
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Provider Name | SARAH JEAN WISE LISW-CP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 4 CARRIAGE LN STE 308
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City | CHARLESTON
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State | SC
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Zip | 29407-6050
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Country | US
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Telephone | 800-552-4357
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Fax | 678-388-9244
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Provider Business Mailing Address
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Address Line | 1710 TROLLEY RD STE E
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8281
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Country | US
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Telephone | 180-055-2435
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Fax | 678-388-9244
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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 | 9553
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License Number State | SC
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