Individual
ILLYANA MARIE ANNUNZIATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, BC-TMH, NCC
Contact information
Practice address
4466 HOLMESTOWN RD, MYRTLE BEACH, SC 29588-7490
(585) 329-5064
Mailing address
1740 PROMISE PL, MYRTLE BEACH, SC 29588-5008
(585) 329-5064
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7105
SC
Other
Enumeration date
03/18/2021
Last updated
03/19/2021
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