Basic Information
| Provider Information | |||||||||
| NPI: | 1336203991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEMON | ||||||||
| FirstName: | KISHA | ||||||||
| MiddleName: | SHARELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 LONGCREEK DR APT 2603 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292107159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036734351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2228 HARRINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291083026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032760794 | ||||||||
| FaxNumber: | 8032766669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.