Provider Demographics
NPI:1184757619
Name:KIDS INTERVENTION TRANSITION
Entity type:Organization
Organization Name:KIDS INTERVENTION TRANSITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN CARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MEDCCCSLP
Authorized Official - Phone:803-647-9515
Mailing Address - Street 1:2144 LEESBURG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2970
Mailing Address - Country:US
Mailing Address - Phone:803-647-9515
Mailing Address - Fax:
Practice Address - Street 1:2144 LEESBURG RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2970
Practice Address - Country:US
Practice Address - Phone:803-647-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty