Healthcare Provider Details

I. General information

NPI: 1609043132
Provider Name (Legal Business Name): STEPHANIE SUE MYERS LPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406
US

IV. Provider business mailing address

7301 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-4650
US

V. Phone/Fax

Practice location:
  • Phone: 843-637-4211
  • Fax: 843-793-3691
Mailing address:
  • Phone: 843-637-4211
  • Fax: 843-793-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: