Individual
ELLEN CANTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301100
—
SC
Enumeration date
09/14/2018
Last updated
09/14/2018
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