Individual
MS. JUDY DURRAH LASSITER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2712 MIDDLEBURG DR, SUITE 206, COLUMBIA, SC 29204-2415
(803) 779-0354
(803) 779-0119
Mailing address
2712 MIDDLEBURG DR, SUITE 206, COLUMBIA, SC 29204-2415
(803) 779-0354
(803) 779-0119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SC LPC 5254
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
582444986
PRIVATE INSURANCE
SC
Enumeration date
03/10/2011
Last updated
03/10/2011
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