Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7251 | SC |
NPI | 1003465261 |
---|---|
Provider Name | Nicole Mckinney |
First Address | Travelers Rest, SC 29690-7606 |
Second Address | Greenville, SC 29615-1168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 04/11/2019 |