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Individual

SCOTT D FAIRWEATHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LISW-CP, CAC-I

Contact information

Practice address
15 MEDICAL PARK, SUITE 300, COLUMBIA, SC 29203-6894
(803) 434-4300
Mailing address
15 MEDICAL PARK, SUITE 300, COLUMBIA, SC 29203-6894
(803) 434-4300
(803) 434-4351

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1005207
SC
101YM0800X
Mental Health Counselor
8866
SC
101YM0800X
Mental Health Counselor
1041C0700X
Clinical Social Worker
Primary
8866
SC

Other

Enumeration date
02/28/2007
Last updated
09/30/2010
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