Healthcare Provider Details

I. General information

NPI: 1225719461
Provider Name (Legal Business Name): AGNES A ROSA CABRERA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 2ND LOOP RD
FLORENCE SC
29501-6123
US

IV. Provider business mailing address

1920 2ND LOOP RD
FLORENCE SC
29501-6123
US

V. Phone/Fax

Practice location:
  • Phone: 843-629-0236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11660
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: