Individual
KATERRA TAJUAN BASKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1547 PARKWAY, GREENWOOD, SC 29646-4081
(864) 229-7120
Mailing address
PO BOX 41, EDGEFIELD, SC 29824-0041
(803) 637-9336
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3335
MEDICARE
SC
05
—
421504
—
SC
Enumeration date
08/17/2018
Last updated
09/30/2022
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