MEDICARE: LOUIS CARN 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	101YM0800X	Mental Health Counselor	10392	SC
2	1041C0700X	Clinical Social Worker	10392	SC

General Provider Information

NPI Number	:	1861869059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS CARN LISW-CP

Provider Business Mailing Address
First Line	:	1717 GERVAIS ST STE 104
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-560-8208
Fax Number	:	803-560-8210

Provider Business Practice Location Address
First Line	:	1717 GERVAIS ST STE 104
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-560-8208
Fax Number	:	803-560-8210

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/16/2024

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Directions to “ LOUIS CARN LISW-CP” Practice Location

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