Provider Demographics
NPI:1225064462
Name:MANALICH, PEGGY D (MSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:D
Last Name:MANALICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 EDGEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3205
Mailing Address - Country:US
Mailing Address - Phone:864-227-3908
Mailing Address - Fax:864-227-2668
Practice Address - Street 1:1033 EDGEFIELD ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3205
Practice Address - Country:US
Practice Address - Phone:864-227-3908
Practice Address - Fax:864-227-2668
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5145101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1098Medicaid
SCSW1098Medicaid
SCQM0225Medicaid