MEDICARE: MRS. CAROL LYNN KONOPASKI 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	101Y00000X	Counselor	5310	SC
2	101YM0800X	Mental Health Counselor	5310	SC
3	101YP2500X	Professional Counselor	5310	SC

General Provider Information

NPI Number	:	1467629568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL LYNN KONOPASKI LPC

Provider Business Mailing Address
First Line	:	PO BOX 904
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-0904
Country	:	US
Telephone Number	:	864-430-2538
Fax Number	:	866-868-7889

Provider Business Practice Location Address
First Line	:	1090 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-430-2538
Fax Number	:	866-868-7889

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	07/28/2016

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