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Individual

TAYLA FORTENBERRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, ED.S, LPC

Contact information

Practice address
301 ANDERSON ST, GREENVILLE, SC 29601-4022
(864) 283-0637
(864) 283-0638
Mailing address
111 MADISON RIDGE RD, PIEDMONT, SC 29673-7915
(864) 494-5462

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6611
SC

Other

Enumeration date
08/17/2017
Last updated
08/17/2017
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