Provider Demographics
NPI:1053710178
Name:GAINEY, CHARLENE G (LISW-CP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:G
Last Name:GAINEY
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:GLOVER, WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PARKWAY
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6807
Mailing Address - Country:US
Mailing Address - Phone:803-335-1219
Mailing Address - Fax:803-335-1689
Practice Address - Street 1:41 UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE 2300
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6807
Practice Address - Country:US
Practice Address - Phone:803-335-1219
Practice Address - Fax:803-335-1689
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1196Medicaid
SCQ48809D896Medicare PIN