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General NPI Number Information
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NPI Number | 1588987218
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Entity Type | Organization
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Legal Business Name | HYPNOSIS PLUS, LLC
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 2323 SAINT MATTHEWS RD
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City | ORANGEBURG
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State | SC
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Zip | 29118-2042
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Country | US
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Telephone | 803-707-8397
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 FAIRWAY DR
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City | ORANGEBURG
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State | SC
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Zip | 29118-4005
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Country | US
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Telephone | 803-707-8397
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. LOREL HUMBURG
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Credential | LISW-CP, CH
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Telephone | 803-707-8397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | SC6583
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License Number State | SC
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