Provider Demographics
NPI:1962087940
Name:CONNER, MARIAH ELAINE (MSW, LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:ELAINE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:ELAINE
Other - Last Name:FRITCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW
Mailing Address - Street 1:949 APPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8196
Mailing Address - Country:US
Mailing Address - Phone:815-721-9466
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:815-721-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190229421041C0700X
SC135751041C0700X
WY11991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical