Individual
CARMELITA VONCILLE MCDANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 COLUMBIA NORTHEAST DR, COLUMBIA, SC 29223-6433
(803) 821-8497
Mailing address
1120 MENLO DR, COLUMBIA, SC 29210-6552
(803) 821-8497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32456
SC
Other
Enumeration date
03/26/2019
Last updated
03/26/2019
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