Provider Demographics
NPI:1225197064
Name:WEATHERS, NATALIE D (LISW-CP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:D
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:D
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:6439 GARNERS FERRY ROAD
Mailing Address - Street 2:#122
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY ROAD
Practice Address - Street 2:#122
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036631041C0700X
SCSW6618CP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical