Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LMSW 6218 | SC |
NPI | 1336307750 |
---|---|
Provider Name | Bertha M Phillips |
First Address | Chapin, SC 29036-8386 |
Second Address | Chapin, SC 29036-8386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |