Individual
VICTORIA WAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
306 AIRPORT DR, MONCKS CORNER, SC 29461-2629
(843) 761-8272
(843) 719-3025
Mailing address
306 AIRPORT DR, MONCKS CORNER, SC 29461-2629
(843) 761-8272
(843) 719-3025
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972574101
—
SC
Enumeration date
05/16/2022
Last updated
05/16/2022
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