Healthcare Provider Details

I. General information

NPI: 1629074604
Provider Name (Legal Business Name): HELENE F. STOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PLANTATION PARK RD BLDG 400
BLUFFTON SC
29910-9009
US

IV. Provider business mailing address

2 LITTLE JOHNS RETREAT
BLUFFTON SC
29910-5705
US

V. Phone/Fax

Practice location:
  • Phone: 843-290-6828
  • Fax: 843-757-3993
Mailing address:
  • Phone: 843-290-6828
  • Fax: 843-757-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1017
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: