Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1053624262 |
---|---|
Provider Name | Miss Stephanie R Jamison |
First Address | Holly Hill, SC 29059-0100 |
Second Address | Holly Hill, SC 29059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 18/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103BHS | (05) | SC |