Basic Information
| Provider Information | |||||||||
| NPI: | 1619452216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGLETON | ||||||||
| FirstName: | FANTASIA | ||||||||
| MiddleName: | TRENELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 BROGDON CIR | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291538040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039689792 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 215 COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291022638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034352124 | ||||||||
| FaxNumber: | 8034358113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11958 | SC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.