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General NPI Number Information
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NPI Number | 1083037162
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Entity Type | Organization
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Legal Business Name | STOVER SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 1721 EBENEZER RD SUITE 265
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-329-7778
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 EBENEZER RD SUITE 265
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-329-7778
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER (LISW-CP)
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Name | HILARY ROE STOVER
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Credential | LISW-CP
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Telephone | 803-329-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9361
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License Number State | SC
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