Active NPI
Acquanita Pettis, LCSW, LISW-CP
- Clinical Psychologist
- Rock Hill, SC
National Provider Identifier
1508628033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 16505
- Practice address
- 1961 Brookstone Way Apt 304
Rock Hill, SC 29732-2688 - Phone
- (561) 503-8230
- NPI assigned
- Jan 30, 2024
- Sex
- Female
- 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 Psychologist | 103TC0700X | 16505 | SC | Primary |
Addresses
Primary practice location
1961 Brookstone Way Apt 304
Rock Hill, SC 29732-2688
Mailing address
1961 Brookstone Way Apt 304
Rock Hill, SC 29732-2688
Phone (561) 503-8230
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16505 | SC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1508628033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1961 BROOKSTONE WAY APT 304",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297322688",
"telephone_number": "561-503-8230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1961 BROOKSTONE WAY APT 304",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297322688",
"telephone_number": "561-503-8230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS",
"first_name": "ACQUANITA",
"credential": "LCSW, LISW-CP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-30",
"last_updated": "2024-01-30",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "16505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.