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1184194250 NPI number — PATRICIA L COSTILLA LPC

NPI Number: 1184194250
Health Care Provider/Practitioner: PATRICIA L COSTILLA LPC

Information about “1184194250” NPI (PATRICIA L COSTILLA LPC) exists in 1184194250 in HTML format HTML  |  1184194250 in plain Text format TXT  |  1184194250 in PDF (Portable Document Format) PDF  |  1184194250 in an XML format XML  formats.

NPI Number : 1184194250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184194250",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COSTILLA",
    "FirstName": "PATRICIA",
    "MiddleName": "L",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "275 CHEYENNE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUMMERVILLE",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29483-8301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "803-743-6128",
    "MailingAddressFaxNumber": "854-300-4965",
    "FirstLinePracticeLocationAddress": "1140 BOONE HILL RD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SUMMERVILLE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29483-2402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-695-9997",
    "PracticeLocationAddressFaxNumber": "854-300-4965",
    "EnumerationDate": "11/30/2018",
    "LastUpdateDate": "09/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "6630",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "7168",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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