Individual
ELLEN WALLACE MABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 STATE RD, CHERAW, SC 29520-7113
(843) 537-0961
(843) 537-0908
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
(843) 857-0206
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10797
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LW1023
—
SC
01
—
SCS392
MEDICARE
—
Enumeration date
06/13/2014
Last updated
03/20/2024
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