| Anderson District 4 | |
|
315 E Queen St Pendleton SC 29670-1721 | |
| (864) 403-2000 | |
| (864) 403-2099 |
| Full Name | Anderson District 4 |
|---|---|
| Speciality | Psychologist - School |
| Location | 315 E Queen St, Pendleton, South Carolina |
| Authorized Official Name and Position | Thomas Wayne Goodwin (DIRECTOR OF SPECIAL EDUCATION) |
| Authorized Official Contact | 8644032000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Anderson District 4 315 E Queen St Pendleton SC 29670-1721 Ph: (864) 403-2000 | Anderson District 4 315 E Queen St Pendleton SC 29670-1721 Ph: (864) 403-2000 |
| NPI Number | 1508102328 |
|---|---|
| Provider Enumeration Date | 12/26/2012 |
| Last Update Date | 12/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508102328 | NPI | - | NPPES |
| SD0404 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TS0200X | Psychologist - School | 3046 (South Carolina) | Primary |