Provider Demographics
NPI:1164757001
Name:MINER, CAROLYN P (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:P
Last Name:MINER
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 1:914 MEETING ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-7308
Mailing Address - Country:US
Mailing Address - Phone:803-233-3199
Mailing Address - Fax:803-233-8420
Practice Address - Street 1:914 MEETING ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7308
Practice Address - Country:US
Practice Address - Phone:803-233-3199
Practice Address - Fax:803-233-8420
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical