Provider Demographics
NPI:1588987218
Name:HYPNOSIS PLUS, LLC
Entity type:Organization
Organization Name:HYPNOSIS PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP, CH
Authorized Official - Phone:803-707-8397
Mailing Address - Street 1:2525 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-4005
Mailing Address - Country:US
Mailing Address - Phone:803-707-8397
Mailing Address - Fax:
Practice Address - Street 1:2323 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2042
Practice Address - Country:US
Practice Address - Phone:803-707-8397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC6583261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1164457719OtherINDIVIDUAL