Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | BBH-LCPC-LIC-16486 | MT |
NPI | 1003340530 |
---|---|
Provider Name | Karan Fleming |
First Address | Sumter, SC 29150-4232 |
Second Address | Sumter, SC 29150-4232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 11/04/2017 |