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General NPI Number Information
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NPI Number | 1306071576
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Entity Type | Individual
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Provider Name | THOMAS SHANE AXSON LPC
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Gender | Male
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 355 WOODRUFF RD
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City | GREENVILLE
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State | SC
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Zip | 29607-3429
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Country | US
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Telephone | 864-350-6335
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25538
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City | GREENVILLE
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State | SC
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Zip | 29616-0538
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Country | US
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Telephone | 864-286-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4727
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License Number State | SC
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