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General NPI Number Information
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NPI Number | 1861869695
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Entity Type | Individual
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Provider Name | MARY ANN ST JOHN MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 810 DUTCH SQUARE BLVD STE 207
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City | COLUMBIA
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State | SC
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Zip | 29210-7318
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Country | US
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Telephone | 803-216-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 333 HUNTERS BLIND DR
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City | COLUMBIA
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State | SC
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Zip | 29212-1651
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Country | US
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Telephone | 803-727-8827
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Fax |
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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 | 6173
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License Number State | SC
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