MEDICARE: MS. NANCY GORDON DARBY MED MAC MFT DOTSAP

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	106H00000X	Marriage & Family Therapist	157	SC

General Provider Information

NPI Number	:	1568493492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY GORDON DARBY MED MAC MFT DOTSAP

Provider Business Mailing Address
First Line	:	120 PRESS LINDLER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8011
Country	:	US
Telephone Number	:	803-407-7661
Fax Number	:	803-407-7661

Provider Business Practice Location Address
First Line	:	120 PRESS LINDLER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8011
Country	:	US
Telephone Number	:	803-407-7661
Fax Number	:	803-407-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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