Provider Demographics
NPI:1912338294
Name:STEPHEN
Entity Type:Organization
Organization Name:STEPHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:843-834-6037
Mailing Address - Street 1:9588 MARKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8585
Mailing Address - Country:US
Mailing Address - Phone:843-834-6037
Mailing Address - Fax:
Practice Address - Street 1:9588 MARKLEY BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8585
Practice Address - Country:US
Practice Address - Phone:843-834-6037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5327251S00000X
SC12033037251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health