Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | SC |
NPI | 1003270794 |
---|---|
Provider Name | Mr. Edmund Jackson Scott JR. |
First Address | Greer, SC 29650-3212 |
Second Address | Spartanburg, SC 29306-3234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 08/04/2016 |