Individual
STACIE MOULTRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1850 PINEVIEW DR, COLUMBIA, SC 29209-5085
(803) 783-0303
Mailing address
PO BOX 4261, COLUMBIA, SC 29240-4261
(803) 477-4731
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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