Individual ProviderAmanda TadlockCounselorBehavioral Health & Social Service ProvidersPractice Address3965 Fish Hatchery Rd, Gaston, SC 29053-9038(803) 755-2261(803) 996-1500PECOS EnrollmentBased on the most recent information from CMS, provider Amanda Tadlock is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1659701829Provider TypeIndividualFull NameTadlock, AmandaCredentialED.S., M.A.GenderFemaleSole ProprietorNoEnumeration Date11/25/2013Last Updated11/25/2013Contact InformationPractice LocationPractice Address3965 Fish Hatchery Rd, Gaston, SC 29053-9038Phone(803) 755-2261FaxUnlisted FaxMailing LocationMailing Address301 Palmetto Park Blvd, Lexington, SC 29072-7872Phone(803) 996-1500FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense0701005494Virginia