Provider Demographics
NPI:1093739195
Name:ROSS, NANCY S (LISW-CP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8212
Mailing Address - Country:US
Mailing Address - Phone:803-730-4993
Mailing Address - Fax:803-434-4918
Practice Address - Street 1:10000 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2361
Practice Address - Country:US
Practice Address - Phone:803-730-4993
Practice Address - Fax:803-434-4918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5021OtherSTATE LICENSURE