Individual
MS. LISA ANNE SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1709 LAUREL ST., COLUMBIA, SC 29201-2624
(803) 765-0700
(803) 765-1607
Mailing address
1709 LAUREL ST., COLUMBIA, SC 29201-2624
(803) 765-0700
(803) 765-1607
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3419
SC
Other
Enumeration date
03/09/2007
Last updated
03/31/2022
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