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General NPI Number Information
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NPI Number | 1578298162
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Entity Type | Individual
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Provider Name | LEAH SUZANNE ECKSTROM LPC/A
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 6334 SAINT ANDREWS RD STE 103
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City | COLUMBIA
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State | SC
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Zip | 29212-3143
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Country | US
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Telephone | 803-764-0961
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Fax | 803-764-4089
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Provider Business Mailing Address
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Address Line | 6334 SAINT ANDREWS RD STE 103
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City | COLUMBIA
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State | SC
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Zip | 29212-3143
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Country | US
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Telephone | 803-764-0961
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Fax | 803-764-4089
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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 | 7618
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License Number State | SC
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