Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6335 | SC |
N | 101YP1600X | Pastoral Counselor |
NPI | 1184978686 |
---|---|
Provider Name | Ms. Renee Evadne Sutton |
First Address | Beaufort, SC 29903-4256 |
Second Address | Beaufort, SC 29902-4915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 31/03/2017 |