Healthcare Provider Details

I. General information

NPI: 1356322481
Provider Name (Legal Business Name): DONNA ELAINE STROM ED S LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W MARTINTOWN RD SUITE 105
NORTH AUGUSTA SC
29841-3175
US

IV. Provider business mailing address

419 W MARTINTOWN RD SUITE 105
NORTH AUGUSTA SC
29841-3175
US

V. Phone/Fax

Practice location:
  • Phone: 803-640-0679
  • Fax: 866-277-2650
Mailing address:
  • Phone: 803-640-0679
  • Fax: 866-277-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3053
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: