| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 301 Main St, Conway, South Carolina |
| Authorized Official Name and Position | Mandy F Mitchell (OWNER) |
| Authorized Official Contact | 2088904693 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8215 Timber Ridge Rd Conway SC 29526-9007 Ph: (208) 890-4693 | 301 Main St Conway SC 29526-5132 Ph: (208) 890-4693 |
| NPI Number | 1598369282 |
|---|---|
| Provider Enumeration Date | 11/24/2020 |
| Last Update Date | 08/15/2024 |
| Certification Date | 08/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598369282 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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