Provider Demographics
NPI:1417053976
Name:WADSWORTH, REBECCA ROTAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ROTAN
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8009
Mailing Address - Country:US
Mailing Address - Phone:803-296-5990
Mailing Address - Fax:803-296-2400
Practice Address - Street 1:223 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8009
Practice Address - Country:US
Practice Address - Phone:803-296-5990
Practice Address - Fax:803-296-2400
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker