Healthcare Provider Details

I. General information

NPI: 1679917363
Provider Name (Legal Business Name): MS. TEAVIS VALENCIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N ACADEMY ST
KINGSTREE SC
29556-3408
US

IV. Provider business mailing address

500 N ACADEMY ST
KINGSTREE SC
29556-3408
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-5533
  • Fax:
Mailing address:
  • Phone: 843-355-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: