Provider Demographics
NPI:1851551410
Name:ANDERSON, NICOLE LANEE' (MSW, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LANEE'
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LANEE'
Other - Last Name:REEDUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4337 CRICKET DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-0904
Mailing Address - Country:US
Mailing Address - Phone:803-531-2125
Mailing Address - Fax:
Practice Address - Street 1:4337 CRICKET DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-0904
Practice Address - Country:US
Practice Address - Phone:803-531-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical