MEDICARE: MRS. MAXINE LATRICE BROWN-SARTOR NCC

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	5682	SC
2	101YM0800X	Mental Health Counselor	229993
3	101YS0200X	School Counselor	242408	SC

General Provider Information

NPI Number	:	1659713493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAXINE LATRICE BROWN-SARTOR NCC

Provider Business Mailing Address
First Line	:	140 STONERIDGE DR STE 350
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-8258
Country	:	US
Telephone Number	:	803-779-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 STONERIDGE DR STE 350
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-8258
Country	:	US
Telephone Number	:	803-779-5500
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “ MRS. MAXINE LATRICE BROWN-SARTOR NCC” Practice Location

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