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NPI Code Detail

MEDICARE: MS. TAMARA A WILLARD LPC

MEDICARE: MS. TAMARA A WILLARD LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor4859SC

General Provider Information

NPI Number : 1518138742
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMARA A WILLARD LPC
Provider Business Mailing Address
First Line : 305 MAPLE ST
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-3902
Country : US
Telephone Number : 843-360-9491
Fax Number : 843-448-8050
Provider Business Practice Location Address
First Line : 4221 MAYFAIR ST
Second Line : SUITE 207
City : MYRTLE BEACH
State : SC
Zip : 29577-5757
Country : US
Telephone Number : 843-360-9491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2008
Last Update Date : 11/10/2009

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