Provider Demographics
NPI:1568200855
Name:KANIPE, LILYANN MAE
Entity type:Individual
Prefix:
First Name:LILYANN
Middle Name:MAE
Last Name:KANIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 LAVINGTON CT PO BOX 95
Mailing Address - Street 2:APT 206
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:864-542-7985
Mailing Address - Fax:
Practice Address - Street 1:130 HUDSON STREET
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706
Practice Address - Country:US
Practice Address - Phone:803-377-8111
Practice Address - Fax:803-581-5380
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD23CSMedicaid