Provider Demographics
NPI:1225556590
Name:SUDIE M CLEM LLC
Entity Type:Organization
Organization Name:SUDIE M CLEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUDIE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CLEM
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:864-344-3484
Mailing Address - Street 1:112 BYPASS 225
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-1154
Mailing Address - Country:US
Mailing Address - Phone:864-344-3484
Mailing Address - Fax:864-977-3480
Practice Address - Street 1:112 BYPASS 225
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-344-3484
Practice Address - Fax:864-977-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty