MEDICARE: LAQUANDRA KRITESE NESMITH M.A.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1093748709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUANDRA KRITESE NESMITH M.A.

Provider Business Mailing Address
First Line	:	8100 GARNERS FERRY ROAD
Second Line	:	APARTMENT 436
City	:	COLUMBIA
State	:	SC
Zip	:	29209
Country	:	US
Telephone Number	:	803-234-6603
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-898-4777
Fax Number	:	803-898-4855

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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