Individual
LARA JENNIFER TIBERIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2108 SHORT GRASS CT, MOUNT PLEASANT, SC 29466-8161
(843) 343-1654
Mailing address
2108 SHORT GRASS CT, MOUNT PLEASANT, SC 29466-8161
(843) 343-1654
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4236
SC
Other
Enumeration date
12/29/2012
Last updated
07/11/2016
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