Provider Demographics
NPI:1720289457
Name:COSTON, CAROL C (MS)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:C
Last Name:COSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 MIDDLEBURG DR
Mailing Address - Street 2:SUITE 313-B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2413
Mailing Address - Country:US
Mailing Address - Phone:803-779-0888
Mailing Address - Fax:803-799-1269
Practice Address - Street 1:2711 MIDDLEBURG DR
Practice Address - Street 2:SUITE 313-B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2413
Practice Address - Country:US
Practice Address - Phone:803-779-0888
Practice Address - Fax:803-799-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC73235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist