MEDICARE: MRS. ALICESON MCCORMICK LISW-CP

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	7666	SC

General Provider Information

NPI Number	:	1619033891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICESON MCCORMICK LISW-CP

Provider Business Mailing Address
First Line	:	PO BOX 38045
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-0536
Country	:	US
Telephone Number	:	803-817-7837
Fax Number	:	803-324-4644

Provider Business Practice Location Address
First Line	:	2241 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9288
Country	:	US
Telephone Number	:	803-817-7837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	01/16/2019

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