MEDICARE: DONALD R GIDNEY LISW-CP, LCSW, LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1916	NC
2	1041C0700X	Clinical Social Worker	C008711	NC
3	1041C0700X	Clinical Social Worker	10722	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891082418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD R GIDNEY LISW-CP, LCSW, LCAS

Provider Business Mailing Address
First Line	:	222 BENNINGTON CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9615
Country	:	US
Telephone Number	:	803-779-5356
Fax Number	:	803-779-2135

Provider Business Practice Location Address
First Line	:	1919 GADSDEN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2346
Country	:	US
Telephone Number	:	803-779-5356
Fax Number	:	803-779-2135

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

Provider Enumeration Date	:	07/03/2011
Last Update Date	:	02/05/2017

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