Provider Demographics
NPI:1053581355
Name:ALDRICH, MARY ANGELA (LISW-CP, LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:LISW-CP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5384
Mailing Address - Country:US
Mailing Address - Phone:803-230-3018
Mailing Address - Fax:803-324-9816
Practice Address - Street 1:454 S. ANDERSON ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-324-9808
Practice Address - Fax:803-324-9816
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCC0057321041C0700X
SC90021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical