Provider Information for 1891154274
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Ms. JOANN RISTAU MS, LPC, NCC
Sex: Female
NPI: 1891154274
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1891154274 | ||||||||
| Enumeration Date | 2016-02-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2615 CORN PILE RD MYRTLE BEACH, SC 29588-8466 United States Phone: 843-655-0379 | Fax: | ||||||||
| Primary Practice Address | 1107 48TH AVE N STE 310A MYRTLE BEACH, SC 29577-5443 United States Phone: 843-655-0379 | Fax:843-655-0379 | ||||||||
| Secondary Practice Address(es) | 2615 CORN PILE RD | ||||||||
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