Individual
MONCINA ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2712 MIDDLEBURG DR STE 207B, COLUMBIA, SC 29204-2445
(803) 261-9479
Mailing address
2712 MIDDLEBURG DR STE 207B, COLUMBIA, SC 29204-2445
(803) 261-9479
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6589
SC
Other
Enumeration date
07/29/2016
Last updated
07/29/2016
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