Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | LPC-5236 | SC |
NPI | 1003092511 |
---|---|
Provider Name | Brian D Musolf |
First Address | Summerville, SC 29485-5203 |
Second Address | Summerville, SC 29485-5203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 02/04/2020 |