Individual
KANEISHA TIERRA WHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CACP
Contact information
Practice address
525 N LAFAYETTE DR, SUMTER, SC 29150-4347
(803) 436-2462
Mailing address
115 N HARVIN ST, SUMTER, SC 29150-4956
(803) 436-2462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/22/2018
Last updated
10/22/2018
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