=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639251028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANNE NORRIS KEA MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 BELTLINE BLVD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29205-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-600-5420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 SOUTH BELTLINE BOULEVARD WM 410
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-600-5420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4693
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------