Provider Demographics
NPI:1285997833
Name:MARSH, CLIFFORD BERNARD (EDS, MS, MSW)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:BERNARD
Last Name:MARSH
Suffix:
Gender:M
Credentials:EDS, MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1218
Mailing Address - Country:US
Mailing Address - Phone:803-788-0038
Mailing Address - Fax:
Practice Address - Street 1:2601 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1218
Practice Address - Country:US
Practice Address - Phone:803-788-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091831041C0700X
DCLC500795091041C0700X
SC72221041C0700X
GACSW0053701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical