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General NPI Number Information
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NPI Number | 1376111070
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Entity Type | Organization
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Legal Business Name | CROWNS FOR QUEENS
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 213 JEFFERS CIR
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City | ELGIN
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State | SC
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Zip | 29045-9258
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Country | US
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Telephone | 843-323-8737
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Fax |
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Provider Business Mailing Address
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Address Line | 10120 TWO NOTCH RD STE 166
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City | COLUMBIA
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State | SC
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Zip | 29223-4395
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Country | US
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Telephone | 803-999-6803
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYLETTE NEWKIRK
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Credential |
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Telephone | 843-323-8737
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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 |
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License Number State |
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