Individual
MR. JORGE ANTONIO PERDOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
900 GREENVILLE DRIVE, WILLIAMSTON, SC 29697
(864) 847-1818
(864) 847-5706
Mailing address
135 CRYSTAL DR, DUNCAN, SC 29334-9320
(864) 439-7800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100
LICENSE #
SC
Enumeration date
02/14/2007
Last updated
07/08/2007
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