Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1005201 | SC |
NPI | 1003102906 |
---|---|
Provider Name | Toya Renee Richardson |
First Address | Summerville, SC 29483-6439 |
Second Address | Summerville, SC 29483-6439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1851476337 | (05) | SC |