Active NPI
Deron Chisolm, LISW
- Clinical Social Worker
- Columbia, SC
National Provider Identifier
1285861617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5177
- Practice address
- 3604 Fernandina Rd
203
Columbia, SC 29210-5221 - Phone
- (803) 750-2211
- NPI assigned
- Jun 11, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5177 | SC | Primary |
Addresses
Primary practice location
3604 Fernandina Rd
203
Columbia, SC 29210-5221
Mailing address
3604 Fernandina Rd
203
Columbia, SC 29210-5221
Phone (803) 750-2211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244678400000",
"number": "1285861617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3604 FERNANDINA RD",
"address_2": "203",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292105221",
"telephone_number": "803-750-2211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3604 FERNANDINA RD",
"address_2": "203",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292105221",
"telephone_number": "803-750-2211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHISOLM",
"first_name": "DERON",
"name_prefix": "Mr.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-11",
"last_updated": "2009-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "SC",
"license": "5177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.