Provider Demographics
NPI:1952646143
Name:LANDRUM, MARTI CARRINGTON (LISW-CP)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:CARRINGTON
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MAGNOLIA ST
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4941
Mailing Address - Country:US
Mailing Address - Phone:803-773-5531
Mailing Address - Fax:803-778-5900
Practice Address - Street 1:105 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4941
Practice Address - Country:US
Practice Address - Phone:803-773-5531
Practice Address - Fax:803-778-5900
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical