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General NPI Number Information
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NPI Number | 1336250760
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Entity Type | Individual
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Provider Name | TAWANDA TOLLIVER-MCHENRY M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 403 STONY LANDING RD
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3967
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Country | US
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Telephone | 843-549-6536
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1030
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3957
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Country | US
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Telephone | 843-524-8899
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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