Anderson District 4 | |
315 E Queen St Pendleton SC 29670-1721 | |
(864) 403-2000 | |
(864) 403-2099 |
Full Name | Anderson District 4 |
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Speciality | Psychologist - School |
Location | 315 E Queen St, Pendleton, South Carolina |
Authorized Official Name and Position | Thomas Wayne Goodwin (DIRECTOR OF SPECIAL EDUCATION) |
Authorized Official Contact | 8644032000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Anderson District 4 315 E Queen St Pendleton SC 29670-1721 Ph: (864) 403-2000 | Anderson District 4 315 E Queen St Pendleton SC 29670-1721 Ph: (864) 403-2000 |
NPI Number | 1508102328 |
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Provider Enumeration Date | 12/26/2012 |
Last Update Date | 12/26/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508102328 | NPI | - | NPPES |
SD0404 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TS0200X | Psychologist - School | 3046 (South Carolina) | Primary |