Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 4694 | SC |
NPI | 1083789994 |
---|---|
Provider Name | Prof. Kerry Lachance |
First Address | Columbia, SC 29203 |
Second Address | Columbia, SC 29203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 16/12/2008 |