Provider Demographics
NPI:1346311339
Name:FAULKENBERRY, RENDA KAY (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:RENDA
Middle Name:KAY
Last Name:FAULKENBERRY
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 EBENEZER RD.
Mailing Address - Street 2:SUITE J-2
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-366-2525
Mailing Address - Fax:803-366-2527
Practice Address - Street 1:2025 EBENEZER RD
Practice Address - Street 2:SUITE J-2
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1062
Practice Address - Country:US
Practice Address - Phone:803-366-2525
Practice Address - Fax:803-366-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00192033OtherRAILROAD MEDICARE