Healthcare Provider Details

I. General information

NPI: 1497874747
Provider Name (Legal Business Name): LLORA JEAN NEGRO MILLER LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LLORA JEAN NEGRO LMSW

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8828
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8868
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: