MEDICARE: GERIATRIC & FAMILY COUNSELING OF COLUMBIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558508895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC & FAMILY COUNSELING OF COLUMBIA, LLC

Provider Business Mailing Address
First Line	:	14 MALLET HILL CT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-3126
Country	:	US
Telephone Number	:	803-740-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MALLET HILL CT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-3126
Country	:	US
Telephone Number	:	803-740-5717
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KAREN ANN SHANLEY
Credential	:	LISW-CP
Telephone Number	:	803-528-5579

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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