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Individual

MS. LATOYA SAMUEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
HLPC, RC, RCI

Contact information

Practice address
1220 BOWER PKWY STE E5, COLUMBIA, SC 29212-3729
(803) 206-9568
Mailing address
1220 BOWER PKWY STE E5, COLUMBIA, SC 29212-3729
(803) 206-9568

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
61285
SC
335E00000X
Prosthetic/Orthotic Supplier
Primary
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
35267
COSMETOLOGY INSTRUCTOR
SC
01
61285
COSMETOLOGY
SC
01
7247
HAIR LOSS PRACTIONER CERTIFICATION
SC
Enumeration date
03/10/2021
Last updated
10/24/2021
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