Credentials Update Package

Is it time for you to go through recredentialing?

Download and fill out the Credentialing Update form, then fax the completed form and required documentation to 803-264-4795.

Required documentation includes:

  • State license(s)
  • Current DEA certificate, if applicable
  • Proof of malpractice coverage, including supplemental coverage
  • Board Specialist certificate, if applicable

Initial Credentialing

If you have never been credentialed, please visit the Credentialing page.