Healthcare Provider Details

I. General information

NPI: 1528157096
Provider Name (Legal Business Name): CAROL MARIE CUPPLES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 ADAMS GRV SUITE 110
COLUMBIA SC
29203-6951
US

IV. Provider business mailing address

2113 ADAMS GRV
COLUMBIA SC
29203-6951
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-1737
  • Fax: 803-256-1737
Mailing address:
  • Phone: 803-256-1737
  • Fax: 803-256-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4744
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: