Provider Demographics
NPI:1669599544
Name:ABERCROMBIE, CHARLES ANTHONY (LISW CP&AP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:ABERCROMBIE
Suffix:
Gender:M
Credentials:LISW CP&AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 CHIMNEY SWIFT LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5418
Mailing Address - Country:US
Mailing Address - Phone:803-794-1732
Mailing Address - Fax:
Practice Address - Street 1:1716 CHIMNEY SWIFT LN
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5418
Practice Address - Country:US
Practice Address - Phone:803-794-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical