Provider Demographics
NPI:1588788673
Name:WRIFFORD, ANTHONY L (LISW-CP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:WRIFFORD
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2402
Mailing Address - Country:US
Mailing Address - Phone:803-201-0805
Mailing Address - Fax:
Practice Address - Street 1:2212 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2402
Practice Address - Country:US
Practice Address - Phone:803-201-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1044Medicaid