Provider Demographics
NPI:1447331913
Name:HARTLEY, ERIC GREY (MSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:GREY
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 DUNCAN ST
Mailing Address - Street 2:APT 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2561
Mailing Address - Country:US
Mailing Address - Phone:803-622-9760
Mailing Address - Fax:
Practice Address - Street 1:600 KING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2313
Practice Address - Country:US
Practice Address - Phone:803-256-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health