Individual
CAROLINA BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417366501
—
SC
Enumeration date
08/04/2014
Last updated
09/13/2016
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