Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4367 | SC |
N | 101YS0200X | School Counselor | 214724 | SC |
NPI | 1124201413 |
---|---|
Provider Name | Lydia Celestine Bailey-Padgett |
First Address | State Park, SC 29147-0047 |
Second Address | Columbia, SC 29201-2923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2007 |
Last Update Date | 11/12/2007 |