MEDICARE: MS. ELIZABETH M. STRADFORD

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		SC

General Provider Information

NPI Number	:	1255698668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH M. STRADFORD

Provider Business Mailing Address
First Line	:	PO BOX 182
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29021-0182
Country	:	US
Telephone Number	:	803-549-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 JAMES WEST LN
Second Line	:
City	:	CASSATT
State	:	SC
Zip	:	29032-9421
Country	:	US
Telephone Number	:	803-549-0900
Fax Number	:

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

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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