Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003355819 |
---|---|
Provider Name | Andrew James Tallarico |
First Address | Greenville, SC 29607-2410 |
Second Address | Greenville, SC 29607-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2017 |
Last Update Date | 14/02/2017 |