Basic Information
| Provider Information | |||||||||
| NPI: | 1255432340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADGETT | ||||||||
| FirstName: | DAPHINE | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PADGETT | ||||||||
| OtherFirstName: | CATHERINE | ||||||||
| OtherMiddleName: | DAPHINE G. | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1547 PARKWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296464081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642297120 | ||||||||
| FaxNumber: | 8642295526 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 TRAVIS AVE | ||||||||
| Address2: | |||||||||
| City: | SALUDA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291381224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644458122 | ||||||||
| FaxNumber: | 8644459546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 421504 | 05 | SC | MEDICAID |