Healthcare Provider Details

I. General information

NPI: 1417428228
Provider Name (Legal Business Name): SKYLAR WOODBERRY HEPLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 WOODTRAIL DR
COLUMBIA SC
29210-6638
US

IV. Provider business mailing address

2012 WOODTRAIL DR
COLUMBIA SC
29210-6638
US

V. Phone/Fax

Practice location:
  • Phone: 843-450-3109
  • Fax:
Mailing address:
  • Phone: 843-450-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6651
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: