Individual
TIERA MAYFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5307 N MAIN ST, COLUMBIA, SC 29203-6113
(803) 546-5334
Mailing address
5307 N MAIN ST, COLUMBIA, SC 29203-6113
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6758
—
SC
Enumeration date
09/01/2015
Last updated
09/01/2015
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