Individual
CONSTANCE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 ATRIUM WAY STE 110, COLUMBIA, SC 29223-6382
(803) 791-7328
(803) 791-4198
Mailing address
115 ATRIUM WAY STE 110, COLUMBIA, SC 29223-6382
(803) 791-7328
(803) 791-4198
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
06/06/2016
Last updated
03/14/2019
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