Healthcare Provider Details

I. General information

NPI: 1033455563
Provider Name (Legal Business Name): LAURA HAMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N HAMILTON ST
WILLIAMSTON SC
29697-1061
US

IV. Provider business mailing address

607 E FIFTH ST
SWANSEA SC
29160-9702
US

V. Phone/Fax

Practice location:
  • Phone: 864-847-7344
  • Fax: 864-847-3543
Mailing address:
  • Phone: 803-568-1000
  • Fax: 803-568-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4612
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: