Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 05101411 | SC |
N | 101YP1600X | Pastoral Counselor | AAPC FELLOW | VA |
N | 1041C0700X | Clinical Social Worker | 5004 | SC |
NPI | 1073607602 |
---|---|
Provider Name | Kathy T Heustess |
First Address | Myrtle Beach, SC 29577 |
Second Address | Myrtle Beach, SC 29577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |