Provider Demographics
NPI:1942336904
Name:SIDDALL, YVONNE (LPC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:SIDDALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FLORENCE ST SW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3890
Mailing Address - Country:US
Mailing Address - Phone:803-641-4177
Mailing Address - Fax:
Practice Address - Street 1:104 FLORENCE ST SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3890
Practice Address - Country:US
Practice Address - Phone:803-641-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2821101YP2500X
SC3273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional