Individual
JOHN SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
390 E BOUNDARY DR, SPARTANBURG, SC 29303-3926
(864) 603-4086
Mailing address
PO BOX 1185, DUNCAN, SC 29334-1185
(864) 603-4086
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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