Provider Demographics
NPI:1598849309
Name:STOLL, MARK ANDREW (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:STOLL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6859
Mailing Address - Country:US
Mailing Address - Phone:803-434-2767
Mailing Address - Fax:803-434-2850
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 440
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-434-2767
Practice Address - Fax:803-434-2850
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional