Provider Demographics
NPI:1528189156
Name:LIOTTA, JANE (MS HSCI)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LIOTTA
Suffix:
Gender:F
Credentials:MS HSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 FIRST BAXTER XING
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8948
Mailing Address - Country:US
Mailing Address - Phone:803-487-8619
Mailing Address - Fax:
Practice Address - Street 1:1700 FIRST BAXTER XING
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8948
Practice Address - Country:US
Practice Address - Phone:803-487-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health