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Individual

ICELYNN BALDWIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LISW-CP

Contact information

Practice address
1154 SUNNYSIDE DR, COLUMBIA, SC 29204-3387
(803) 730-1023
(803) 667-4697
Mailing address
1154 SUNNYSIDE DR, COLUMBIA, SC 29204-3387
(803) 730-1023

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10175
SC
1041C0700X
Clinical Social Worker
10175
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10175
CLINICAL LICENSE
SC
05
SW1649
SC
Enumeration date
04/21/2015
Last updated
04/22/2020
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