Provider Demographics
NPI:1821163288
Name:WEINBAUM CLINICAL SERVICES
Entity Type:Organization
Organization Name:WEINBAUM CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:843-629-0034
Mailing Address - Street 1:604 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5223
Mailing Address - Country:US
Mailing Address - Phone:843-629-0034
Mailing Address - Fax:843-629-9192
Practice Address - Street 1:604 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5223
Practice Address - Country:US
Practice Address - Phone:843-629-0034
Practice Address - Fax:843-629-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2044251OtherCIGNA
SCQM0731Medicaid
SCQM0731Medicaid
SC=========OtherBCBS