MEDICARE: CHRISTOPHER RONNIE WHITEHEAD LMSW

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	104100000X	Social Worker	11429	SC

General Provider Information

NPI Number	:	1639814098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RONNIE WHITEHEAD LMSW

Provider Business Mailing Address
First Line	:	315 PLANTATION DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7925
Country	:	US
Telephone Number	:	803-414-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4052
Country	:	US
Telephone Number	:	803-414-1999
Fax Number	:

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

Provider Enumeration Date	:	04/30/2022
Last Update Date	:	04/30/2022

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