Provider Information for 1811577604
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Mrs. KWANIS S. CARLOS LCSW
Sex: Female
NPI: 1811577604
Last Updated: 2023-09-26
Certification Date: 2023-01-12
Certification Date: 2023-01-12
Details
| Name | Value | ||||||||||||||
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| NPI | 1811577604 | ||||||||||||||
| Enumeration Date | 2021-04-14 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 513 RICHFIELD WAY SUMMERVILLE, SC 29486-2490 United States Phone: 404-593-8866 | Fax: | ||||||||||||||
| Primary Practice Address | 201 SIGMA DR STE 300 SUMMERVILLE, SC 29486-7722 United States Phone: 800-811-0723 | Fax: | ||||||||||||||
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