=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164857421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JANET F CRIBB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 S MAIN ST
-----------------------------------------------------
City | HEMINGWAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29554-6442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-558-9413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 168 BAPTIST RD
-----------------------------------------------------
City | HEMINGWAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29554-5843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-558-7303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------