Organization
PSYCHOTHERAPY AND CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA L JUDD LISW-CP (SOLE PROPRIETOR)
(864) 504-0708
Entity
Organization
Contact information
Practice address
504 PARKVIEW DR, SPARTANBURG, SC 29302-4019
(864) 504-0708
Mailing address
504 PARKVIEW DR, SPARTANBURG, SC 29302-4019
(864) 504-0708
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0069
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SW1292-1417958448
—
SC
Enumeration date
06/16/2016
Last updated
08/10/2016
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