Provider Demographics
NPI:1871767095
Name:GOMEZ, TODD STEPHEN (LCSW,LISW)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:STEPHEN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LCSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7343
Mailing Address - Country:US
Mailing Address - Phone:864-263-7532
Mailing Address - Fax:803-324-4644
Practice Address - Street 1:248 ADLEY WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6511
Practice Address - Country:US
Practice Address - Phone:864-263-7532
Practice Address - Fax:803-324-4644
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62541041C0700X
NCC0074451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical