Individual
MRS. TABITHA GAIL HENNAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3080 HIGHWAY 15-401 E, MC COLL, SC 29570-6128
(843) 523-5751
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
(843) 857-0206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7984
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC2513
—
SC
01
—
SCR603
MEDICARE
SC
Enumeration date
09/03/2010
Last updated
02/13/2024
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