Provider Demographics
NPI:1356754311
Name:CONWAY, CAROL S (LISW-CP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:CONWAY
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 1:1851 DAWSON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5702
Mailing Address - Country:US
Mailing Address - Phone:843-851-1806
Mailing Address - Fax:
Practice Address - Street 1:112 PALADIN DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4129
Practice Address - Country:US
Practice Address - Phone:843-412-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional