Healthcare Provider Details
I. General information
NPI: 1720466857
Provider Name (Legal Business Name): DEBRA ANN MUNFORD MS, LPC, LAC, LAC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/08/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3116 SALLY HILL ROAD SUITE 114
TIMMONSVILLE SC
29161
US
IV. Provider business mailing address
28 KENDALS LN
FOUNTAIN INN SC
29644-1770
US
V. Phone/Fax
- Phone: 843-618-4658
- Fax: 843-954-6066
- Phone: 843-618-4658
- Fax: 843-954-6066
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 253 |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 8457 |
| License Number State | SC |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 7221 |
| License Number State | SC |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: