MEDICARE: KATHLEEN NMI HEROLD MED, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1629	SC

General Provider Information

NPI Number	:	1053527689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN NMI HEROLD MED, LPC

Provider Business Mailing Address
First Line	:	2313 KING EDWARD DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5604
Country	:	US
Telephone Number	:	843-276-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 KING EDWARD DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5604
Country	:	US
Telephone Number	:	843-276-0694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	11/02/2009

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