Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 227408 | SC |
NPI | 1093208894 |
---|---|
Provider Name | Sophie Ellis |
First Address | Hanahan, SC 29410-8509 |
Second Address | North Charleston, SC 29406-9147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |