NPI |
1699113720 |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Entity Type Code |
1 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Last Name Legal Name |
LE |
Other name by which the organization provider is or has been known. |
Provider First Name |
STEPHANIE |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
MARIE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Credential Text |
MD |
The city name in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
15 MED PARK STE 141 |
The State code in the location of the provider
being identified. |
Provider Second Line Business Practice Location Address |
GENERAL PSYCHIATRY DEPT |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
COLUMBIA |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
SC |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
29203 |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
8034344300 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
8034344351 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
6/11/2013 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
6/27/2019 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
2084P0800X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
LL35805 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
SC |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |