Healthcare Provider Details

I. General information

NPI: 1043564594
Provider Name (Legal Business Name): DEREK S. SNIPES LPC & LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 COMMERCE DRIVE
DILLON SC
29536
US

IV. Provider business mailing address

PO BOX 918
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-9296
  • Fax:
Mailing address:
  • Phone: 843-544-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6220
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: