Provider Demographics
NPI:1619739844
Name:PRIESTER, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:SC
Mailing Address - Zip Code:29810-0373
Mailing Address - Country:US
Mailing Address - Phone:803-573-7104
Mailing Address - Fax:803-573-7105
Practice Address - Street 1:279 HICKORY ST S
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-4633
Practice Address - Country:US
Practice Address - Phone:803-573-7104
Practice Address - Fax:803-573-7105
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health