Provider Demographics
NPI:1548506421
Name:CAROLINA CHAT & CHEW LLC
Entity type:Organization
Organization Name:CAROLINA CHAT & CHEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:HOLLER
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MSP/CCC-SLP
Authorized Official - Phone:803-622-8851
Mailing Address - Street 1:305 HAMPTON TRACE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1916
Mailing Address - Country:US
Mailing Address - Phone:803-622-8851
Mailing Address - Fax:
Practice Address - Street 1:305 HAMPTON TRACE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1916
Practice Address - Country:US
Practice Address - Phone:803-622-8851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty