Healthcare Provider Details

I. General information

NPI: 1407336910
Provider Name (Legal Business Name): COURTNEY ALISSA SKAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LADY ST
COLUMBIA SC
29201-3402
US

IV. Provider business mailing address

1207 HINNANTS STORE RD
WINNSBORO SC
29180-9453
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-1995
  • Fax:
Mailing address:
  • Phone: 803-553-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6644
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: