Look up the most recent NPI and PECOS records

Amanda Tadlock

Counselor

Behavioral Health & Social Service Providers

3965 Fish Hatchery Rd, Gaston, SC 29053-9038

PECOS Enrollment

Based 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 B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 33 days ago.

Profile Details

Provider ID
1659701829
Provider Type
Individual
Full Name
Tadlock, Amanda
Credential
ED.S., M.A.

Gender
Female
Sole Proprietor
No
Enumeration Date
11/25/2013
Last Updated
11/25/2013

Contact Information

Practice Location

3965 Fish Hatchery Rd, Gaston, SC 29053-9038

(803) 755-2261

Unlisted Fax

Mailing Location

301 Palmetto Park Blvd, Lexington, SC 29072-7872

(803) 996-1500

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 0701005494 Virginia

Amanda Tadlock

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Williams, Angela

Daniels, Carla

Cook, Julianna Brynne

Burke, Janet Lee

Davis, Katasha

Bridgeman, Eria

Williams, Mandy N.

Pearson, Gisela W.

Meglino, Mark Joseph