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NPI Code Detail

MEDICARE: STEPHANIE NICOLE GORE LPC

MEDICARE:   STEPHANIE NICOLE GORE  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
1101YP2500XProfessional Counselor7106SC

General Provider Information

NPI Number : 1073175436
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE NICOLE GORE LPC
Provider Business Mailing Address
First Line : 108 MOCKERNUT DR
Second Line :
City : LADSON
State : SC
Zip : 29456-3892
Country : US
Telephone Number : 843-693-7857
Fax Number :
Provider Business Practice Location Address
First Line : 871 LOWCOUNTRY BLVD
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-3066
Country : US
Telephone Number : 843-501-1009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2019
Last Update Date : 07/05/2019

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Directions to “ STEPHANIE NICOLE GORE LPC” Practice Location

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