Healthcare Provider Details

I. General information

NPI: 1396771465
Provider Name (Legal Business Name): MARTHA V BUSTERNA MED LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VINE CREST COURT SUITE 300
GREENWOOD SC
29646
US

IV. Provider business mailing address

105 VINE CREST COURT SUITE 700
GREENWOOD SC
29646
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-5111
  • Fax: 864-223-9245
Mailing address:
  • Phone: 864-943-4859
  • Fax: 864-943-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2151
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: