Provider Demographics
NPI:1811577604
Name:CARLOS, KWANIS S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KWANIS
Middle Name:S
Last Name:CARLOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 RICHFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2490
Mailing Address - Country:US
Mailing Address - Phone:404-593-8866
Mailing Address - Fax:
Practice Address - Street 1:201 SIGMA DR STE 300
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7722
Practice Address - Country:US
Practice Address - Phone:800-811-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical