Individual
MISS SHANNON DERVAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NCC, CACI
Contact information
Practice address
130 HUDSON ST, CHESTER, SC 29706-1524
(803) 377-8111
(803) 581-5380
Mailing address
444 SCARLETT LN, FORT MILL, SC 29715-8213
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1105055
SC
101YP2500X
Professional Counselor
Primary
5145
SC
101YP2500X
Professional Counselor
56127
NC
101YP2500X
Professional Counselor
8163
NC
Other
Enumeration date
06/30/2011
Last updated
06/30/2011
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