Provider Information for 1396329298
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STACY LEO LISW-CP
Sex: Female
NPI: 1396329298
Last Updated: 2021-05-07
Certification Date: 2021-05-07
Certification Date: 2021-05-07
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1396329298 | ||||||||||||||
| Enumeration Date | 2021-05-07 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 77 HAZZARD CREEK VLG RIDGELAND, SC 29936-8266 United States Phone: 443-235-6161 | Fax: | ||||||||||||||
| Primary Practice Address | 77 HAZZARD CREEK VLG RIDGELAND, SC 29936-8266 United States Phone: 843-645-7700 | Fax: | ||||||||||||||
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