Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003380569 |
---|---|
Provider Name | April Victoria Siders |
First Address | Columbia, SC 29223-1833 |
Second Address | Columbia, SC 29223-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 17/01/2019 |