| Palmetto Center For Change, Llc | |
|
1905 Sunset Blvd Ste C West Columbia SC 29169-5955 | |
| (803) 851-0902 | |
| (803) 851-7192 |
| Full Name | Palmetto Center For Change, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1905 Sunset Blvd Ste C, West Columbia, South Carolina |
| Authorized Official Name and Position | Carol E. O. Anderson (OWNER) |
| Authorized Official Contact | 8038510902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Palmetto Center For Change, Llc Po Box 483 Gilbert SC 29054-0483 Ph: (803) 851-0902 | Palmetto Center For Change, Llc 1905 Sunset Blvd Ste C West Columbia SC 29169-5955 Ph: (803) 851-0902 |
| NPI Number | 1427432046 |
|---|---|
| Provider Enumeration Date | 07/14/2015 |
| Last Update Date | 11/25/2020 |
| Certification Date | 11/25/2020 |
| Medicare PECOS PAC ID | 3577872423 |
|---|---|
| Medicare Enrollment ID | O20151016000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427432046 | NPI | - | NPPES |
| 616366600 | Other | SC | DOL |
| SW1077 | Medicaid | SC | |
| GP7051 | Medicaid | SC | |
| 612752000 | Other | SC | SELECT HEALTH |
| Q371020281 | Other | SC | MEDICARE PTAN |
| QMP000002409221 | Other | SC | MOLINA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6960 (South Carolina) | Primary |
| Provider Name | Carol Eo Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013297928 PECOS PAC ID: 2163694696 Enrollment ID: I20111005000807 |
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