Provider Demographics
NPI:1366652372
Name:TOA, DEBORAH (LISW, MSW)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:TOA
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PINE STREET
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-0969
Mailing Address - Country:US
Mailing Address - Phone:803-943-5228
Mailing Address - Fax:803-943-4591
Practice Address - Street 1:1000 PINE STREET
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-0969
Practice Address - Country:US
Practice Address - Phone:803-943-5228
Practice Address - Fax:803-943-4591
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC013Medicaid
SCRHC013Medicaid