Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 5595 | SC |
NPI | 1003244716 |
---|---|
Provider Name | Ms. Sandra Nelson |
First Address | Charleston, SC 29412-9004 |
Second Address | Mt Pleasant, SC 29464-5426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 06/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5595 | SOUTH CAROLINA DEPARTMENT OF LABOR AND LICENSING: LPC (01) | SC |