Provider Demographics
NPI:1154719342
Name:NISWONGER, REBECCA H (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:H
Last Name:NISWONGER
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:MS
Other - First Name:REBBECCA
Other - Middle Name:E
Other - Last Name:HARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4943
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:215 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4943
Practice Address - Country:US
Practice Address - Phone:803-775-9364
Practice Address - Fax:803-773-6615
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3338Medicaid