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General NPI Number Information
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NPI Number | 1326679606
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Entity Type | Individual
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Provider Name | ROBERTO ANDRE VAZQUEZ SALAS LPC
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Gender | Male
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 26 WESMARK CT
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City | SUMTER
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State | SC
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Zip | 29150-1996
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Country | US
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Telephone | 803-883-4981
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Fax | 803-883-5492
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Provider Business Mailing Address
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Address Line | 3760 PATRIOT PKWY APT 2K
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City | SUMTER
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State | SC
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Zip | 29154-9807
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Country | US
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Telephone | 839-287-3068
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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 | 11505
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License Number State | SC
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