Provider Demographics
NPI:1568839744
Name:FENLEY, GARETH NERISA (LMSW, CPRP)
Entity Type:Individual
Prefix:MS
First Name:GARETH
Middle Name:NERISA
Last Name:FENLEY
Suffix:
Gender:F
Credentials:LMSW, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5757
Mailing Address - Country:US
Mailing Address - Phone:803-479-1287
Mailing Address - Fax:866-803-3296
Practice Address - Street 1:3619 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5757
Practice Address - Country:US
Practice Address - Phone:803-479-1287
Practice Address - Fax:866-803-3296
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10947104100000X
GAMSW003580104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker