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Individual

KENZA GRACE HADDOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1500 HIGHWAY 17 N STE 201H, SURFSIDE BEACH, SC 29575-6078
(843) 284-7147
Mailing address
PO BOX 31537, MYRTLE BEACH, SC 29588-0026
(843) 284-7147

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6800
SC

Other

Enumeration date
10/12/2019
Last updated
10/12/2019
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