MEDICARE: PAULA PRIESTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619739844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA PRIESTER

Provider Business Mailing Address
First Line	:	PO BOX 373
Second Line	:
City	:	ALLENDALE
State	:	SC
Zip	:	29810-0373
Country	:	US
Telephone Number	:	803-573-7104
Fax Number	:	803-573-7105

Provider Business Practice Location Address
First Line	:	279 HICKORY ST S
Second Line	:
City	:	ALLENDALE
State	:	SC
Zip	:	29810-4633
Country	:	US
Telephone Number	:	803-573-7104
Fax Number	:	803-573-7105

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

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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Directions to “ PAULA PRIESTER ” Practice Location

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