MEDICARE: TASHEMA UTSEY

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1982051470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHEMA UTSEY

Provider Business Mailing Address
First Line	:	300 GRACEMOUNT LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7086
Country	:	US
Telephone Number	:	803-306-9147
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 SAINT JULIAN PL STE 300
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2402
Country	:	US
Telephone Number	:	803-306-9147
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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Directions to “ TASHEMA UTSEY ” Practice Location

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