Doctor Name: | DR. JOHN RAY ADDISON |
NPI Number: | 1043589997 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 1844 |
Business Practice Address: | 530 By Pass 123 Suite E2 Seneca, SC - 296780859 |
Business Phone Number: | 8648827600 |
Business Fax Number: | 8648827631 |
Mailing Address: | Po Box 1105, CLEMSON |
State: | SC |
Postal Code: | 296331105 |
Phone Number: | 8648827600 |
Fax Number: | 8648827631 |
NPI Enumeration Date: | 12/21/2011 |
NPI Last Update Date: | 12/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1844 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |