MEDICARE: VANESSA FEOLA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1834	SC

General Provider Information

NPI Number	:	1396281275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA FEOLA PHD

Provider Business Mailing Address
First Line	:	1459 STUART ENGALS BLVD STE 204A
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3600
Country	:	US
Telephone Number	:	843-849-9913
Fax Number	:	843-881-6878

Provider Business Practice Location Address
First Line	:	1459 STUART ENGALS BLVD STE 204A
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3600
Country	:	US
Telephone Number	:	843-849-9913
Fax Number	:	843-881-6878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	11/14/2023

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Directions to “ VANESSA FEOLA PHD” Practice Location

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