Healthcare Provider Details

I. General information

NPI: 1245662204
Provider Name (Legal Business Name): LESLIE 'DAY' G CAUGHMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 W LIBERTY ST
SUMTER SC
29150-4746
US

IV. Provider business mailing address

325 BROAD ST SUITE 100
SUMTER SC
29150-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-774-1094
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-774-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5499
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5499
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: