Organization
PALMETTO CENTER FOR CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL E. O. ANDERSON LISW-CP (OWNER)
(803) 851-0902
Entity
Organization
Contact information
Practice address
1905 SUNSET BLVD STE C, WEST COLUMBIA, SC 29169-5955
(803) 851-0902
(803) 851-7192
Mailing address
PO BOX 483, GILBERT, SC 29054-0483
(803) 851-0902
(803) 851-7192
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6960
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612752000
SELECT HEALTH
SC
01
—
616366600
DOL
SC
05
—
GP7051
—
SC
01
—
Q371020281
MEDICARE PTAN
SC
01
—
QMP000002409221
MOLINA
SC
05
—
SW1077
—
SC
Enumeration date
07/14/2015
Last updated
11/25/2020
Update your record
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