Provider Demographics
NPI:1356010706
Name:KAHN, CLYDE TALMADGE PADGETT (LPCA)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:TALMADGE PADGETT
Last Name:KAHN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5223
Mailing Address - Country:US
Mailing Address - Phone:843-673-0054
Mailing Address - Fax:843-667-1549
Practice Address - Street 1:616 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5223
Practice Address - Country:US
Practice Address - Phone:843-673-0054
Practice Address - Fax:843-667-1549
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional