Provider Demographics
NPI:1083037162
Name:STOVER SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:STOVER SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER (LISW-CP)
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:ROE
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-329-7778
Mailing Address - Street 1:1721 EBENEZER RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-329-7778
Mailing Address - Fax:
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 265
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-329-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty