Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 000581 | SC |
Y | 103TC0700X | Clinical Psychologist | 000581 | SC |
NPI | 1003920208 |
---|---|
Provider Name | Christine Reineke Bachmann |
First Address | Charleston, SC 29407-3424 |
Second Address | Charleston, SC 29407-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080281 | (02) | SC |