MEDICARE: FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1518565928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC

Provider Business Mailing Address
First Line	:	208 ASHEWICKE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7059
Country	:	US
Telephone Number	:	330-280-0716
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LONG POINTE LN STE 220-B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7543
Country	:	US
Telephone Number	:	803-500-5086
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	DR. LISA M GIOVANNELLI
Credential	:	PHD
Telephone Number	:	330-280-0716

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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