Organization
KIDS INTERVENTION TRANSITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA GREEN CARNER M.EDCCCSLP (PRESIDENT)
(803) 647-9515
Entity
Organization
Contact information
Practice address
2144 LEESBURG RD, COLUMBIA, SC 29209-2970
(803) 647-9515
Mailing address
2144 LEESBURG RD, COLUMBIA, SC 29209-2970
(803) 647-9515
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
09428
SC
Other
Enumeration date
03/13/2007
Last updated
07/01/2008
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