Provider Demographics
NPI:1841531373
Name:FORREST, ANNIE LAURIE (LISW-CP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAURIE
Last Name:FORREST
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:LAURIE
Other - Last Name:MCGRANAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:1115 DUNLAP RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2501
Mailing Address - Country:US
Mailing Address - Phone:864-225-0792
Mailing Address - Fax:864-226-3968
Practice Address - Street 1:1115 DUNLAP RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2501
Practice Address - Country:US
Practice Address - Phone:864-225-0792
Practice Address - Fax:864-226-3968
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490147141041C0700X
SC114141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty