Healthcare Provider Details

I. General information

NPI: 1922654177
Provider Name (Legal Business Name): JULIA SHANNON BARBOUR MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 05/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHERAW ST
BENNETTSVILLE SC
29512
US

IV. Provider business mailing address

PO BOX 918
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-454-0442
  • Fax:
Mailing address:
  • Phone: 843-544-4060
  • Fax: 843-454-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: