Provider Demographics
NPI:1497148142
Name:GANZY, RODSHENNA (LPCS HPT LAC BC-TMH)
Entity Type:Individual
Prefix:MRS
First Name:RODSHENNA
Middle Name:
Last Name:GANZY
Suffix:
Gender:F
Credentials:LPCS HPT LAC BC-TMH
Other - Prefix:MRS
Other - First Name:RODSHENNA
Other - Middle Name:
Other - Last Name:GANZY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCS HPT LAC BC-TMH
Mailing Address - Street 1:989 KNOX ABBOTT DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3346
Mailing Address - Country:US
Mailing Address - Phone:803-282-9164
Mailing Address - Fax:
Practice Address - Street 1:4100 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:803-936-1550
Practice Address - Fax:803-306-6848
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRC 54772174H00000X
SC6471101YP2500X
SC7328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174H00000XOther Service ProvidersHealth Educator