Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 272487 | SC |
NPI | 1174916498 |
---|---|
Provider Name | Ms. Michelle Mckenzie |
First Address | Columbia, SC 29203-5177 |
Second Address | Columbia, SC 29203-5177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 11/03/2015 |