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Anderson District 4

Organization Active NPI School Psychologist · Pendleton, SC

NPI 1508102328 · NPPES record last updated Dec 26, 2012

Key facts

NPI
1508102328
Entity type
Organization (NPI type 2)
Primary specialty
School Psychologist 103TS0200X
License
3046 (SC)
Legal business name
ANDERSON DISTRICT 4
Practice address
315 E Queen St
Pendleton, SC 29670-1721
Phone
(864) 403-2000
Fax
(864) 403-2099
NPI assigned
Dec 26, 2012
Organization subpart
No

Authorized official

Name
Mr. Thomas Wayne Goodwin, LPES
Title
Director of Special Education
Phone
(864) 403-2000

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2206111Anderson School District 4
315 E Queen Street, Pendleton, SC 29670		Certificate of waiverDec 16, 2026

National Provider Directory

Tax ID family
Anderson District 4 (6 organizations share this tax ID)

Locations

315 E Queen St
Pendleton, SC 29670
Phone (864) 403-2000

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103TS0200X 3046 SC Yes

Addresses

Primary practice location

315 E Queen St
Pendleton, SC 29670-1721

Mailing address

315 E Queen St
Pendleton, SC 29670-1721
Phone (864) 403-2000

Other identifiers

IdentifierTypeStateIssuer
SD0404MedicaidSC

Other providers in Pendleton, SC

All providers in Pendleton, SC · School Psychologist in South Carolina

Sources for this page

Verify at the official NPI Registry.