Healthcare Provider Details

I. General information

NPI: 1366694580
Provider Name (Legal Business Name): KENDRA MCILVEE TWITTY M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 ETHERIDGE RD
YEMASSEE SC
29945-8834
US

IV. Provider business mailing address

PO BOX 510
RIDGELAND SC
29936-2609
US

V. Phone/Fax

Practice location:
  • Phone: 843-812-1018
  • Fax:
Mailing address:
  • Phone: 843-812-1018
  • Fax: 843-717-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4940
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: