Provider Demographics
NPI:1376160101
Name:MAPP, CARLIE I (LRD)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:I
Last Name:MAPP
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3859
Mailing Address - Country:US
Mailing Address - Phone:864-725-1680
Mailing Address - Fax:864-725-4683
Practice Address - Street 1:1132 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3859
Practice Address - Country:US
Practice Address - Phone:864-725-1680
Practice Address - Fax:864-725-4683
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2245133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered