Provider Demographics
NPI:1609238476
Name:SMITH, ROSALYN DENISE (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:DENISE
Other - Last Name:CAPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:7825 BROAD RIVER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-262-0794
Mailing Address - Fax:
Practice Address - Street 1:7825 BROAD RIVER ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-262-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010982181041C0700X
GACSW0089111041C0700X
TX1116741041C0700X
SC154821041C0700X
NCC0162861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical