Healthcare Provider Details

I. General information

NPI: 1407195829
Provider Name (Legal Business Name): CHARLES D STINSON M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 HUMAN SERVICES RD
CLINTON SC
29325-7548
US

IV. Provider business mailing address

321 N ADAIR ST
CLINTON SC
29325-2405
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-6500
  • Fax: 864-833-6905
Mailing address:
  • Phone: 864-833-6081
  • Fax: 864-833-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: