Provider Demographics
NPI:1508759945
Name:CONYERS, JUSTINA ANN
Entity type:Individual
Prefix:MS
First Name:JUSTINA
Middle Name:ANN
Last Name:CONYERS
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 1:925 MILLER RD APT E8
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2748
Mailing Address - Country:US
Mailing Address - Phone:803-757-9454
Mailing Address - Fax:
Practice Address - Street 1:738 W LIBERTY ST STE B
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4745
Practice Address - Country:US
Practice Address - Phone:803-757-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician