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General NPI Number Information
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NPI Number | 1518565928
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Entity Type | Organization
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Legal Business Name | FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 300 LONG POINTE LN STE 220-B
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City | COLUMBIA
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State | SC
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Zip | 29229-7543
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Country | US
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Telephone | 803-500-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 208 ASHEWICKE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7059
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Country | US
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Telephone | 330-280-0716
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | DR. LISA M GIOVANNELLI
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Credential | PHD
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Telephone | 330-280-0716
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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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