Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003300195 |
---|---|
Provider Name | Ms. Tawan Binnetta Alston |
First Address | Conway, SC 29526-8903 |
Second Address | Conway, SC 29526-8903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |