Provider Demographics
NPI:1760532022
Name:MAUTZ CHARPIA, KIM M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:MAUTZ CHARPIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:CHARPIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202 SALISBURY DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4345
Mailing Address - Country:US
Mailing Address - Phone:843-851-5824
Mailing Address - Fax:843-851-7560
Practice Address - Street 1:202 SALISBURY DR.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-851-5824
Practice Address - Fax:843-851-7560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1883104100000X
SC68106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ312460281Medicare ID - Type Unspecified