Provider Demographics
NPI:1114687035
Name:NIPPER, ANTOINETTE SHANAE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:SHANAE
Last Name:NIPPER
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 1:105 INDIGO PLACE CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-2698
Mailing Address - Country:US
Mailing Address - Phone:803-974-9415
Mailing Address - Fax:
Practice Address - Street 1:105 INDIGO PLACE CT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-2698
Practice Address - Country:US
Practice Address - Phone:803-974-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC148791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical