Healthcare Provider Details

I. General information

NPI: 1841683505
Provider Name (Legal Business Name): ASHLEY V EADDY LPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BELLEVIEW ST
COLUMBIA SC
29201-1871
US

IV. Provider business mailing address

4 WILD IRIS CT
COLUMBIA SC
29209
US

V. Phone/Fax

Practice location:
  • Phone: 803-606-7171
  • Fax:
Mailing address:
  • Phone: 864-378-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5744
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: