1063459642 NPI number — MS. SARA K MCCLAM LISW AP CP

Table of content: MS. SARA K MCCLAM LISW AP CP (NPI 1063459642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063459642 NPI number — MS. SARA K MCCLAM LISW AP CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAM
Provider First Name:
SARA
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW AP CP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICKELSON
Provider Other First Name:
SARA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063459642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 RUNNING FOX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-960-3153
Provider Business Mailing Address Fax Number:
803-905-5653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-775-3060
Provider Business Practice Location Address Fax Number:
803-774-4280
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  001951 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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