Healthcare Provider Details

I. General information

NPI: 1437697224
Provider Name (Legal Business Name): PSYCHOLOGICAL AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PLANTATION PARK DR 202
BLUFFTON SC
29910-6038
US

IV. Provider business mailing address

23 PLANTATION PK DR. 202
BLUFFTON SC
29910
US

V. Phone/Fax

Practice location:
  • Phone: 843-290-6828
  • Fax: 843-757-3993
Mailing address:
  • Phone: 843-290-6828
  • Fax: 843-757-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN1338RX
License Number StateSC

VIII. Authorized Official

Name: DR. HELENE STOLLER
Title or Position: PRACTICE OWNER
Credential: PHD
Phone: 843-290-6828