Provider Demographics
NPI:1891082418
Name:GIDNEY, DONALD R (LISW-CP, LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:GIDNEY
Suffix:
Gender:M
Credentials:LISW-CP, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BENNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9615
Mailing Address - Country:US
Mailing Address - Phone:803-779-5356
Mailing Address - Fax:803-779-2135
Practice Address - Street 1:1919 GADSDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2346
Practice Address - Country:US
Practice Address - Phone:803-779-5356
Practice Address - Fax:803-779-2135
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1916101YA0400X
NCC0087111041C0700X
SC107221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1234Medicaid
SCSW1234Medicaid