Individual
PAMELA CODES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
318 E MAIN ST, PICKENS, SC 29671-2385
(864) 898-5800
Mailing address
318 E MAIN ST, PICKENS, SC 29671-2385
(864) 898-5800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YP2500X
Professional Counselor
9748
SC
Other
Enumeration date
11/25/2019
Last updated
10/11/2024
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