Individual
MR. HARRY STOLL MUSTARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LISW-CP
Contact information
Practice address
3050 LEAPHART RD, WEST COLUMBIA, SC 29169-3000
(803) 791-0495
(803) 791-1958
Mailing address
3050 LEAPHART RD, WEST COLUMBIA, SC 29169-3000
(803) 791-1958
(803) 791-1958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5557
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12211634
CAQH
—
Enumeration date
07/11/2011
Last updated
07/11/2011
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