Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 149 | SC |
NPI | 1003381732 |
---|---|
Provider Name | Stephanie Landers Forrest |
First Address | Johnston, SC 29832-4423 |
Second Address | Greenwood, SC 29649-8513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 09/10/2018 |