Provider Demographics
NPI:1861573412
Name:MORIN, CLYDE PETER (LISW-CP)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:PETER
Last Name:MORIN
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 1:2823 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2503
Mailing Address - Country:US
Mailing Address - Phone:803-799-9827
Mailing Address - Fax:
Practice Address - Street 1:2015 MARION ST,
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29240-4440
Practice Address - Country:US
Practice Address - Phone:803-898-0123
Practice Address - Fax:803-253-4090
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical