Healthcare Provider Details

I. General information

NPI: 1114695228
Provider Name (Legal Business Name): HALEY MARIE FIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 KING ST
CAMDEN SC
29020-4720
US

IV. Provider business mailing address

1690 GINKGO TRL
RIDGEWAY SC
29130-9635
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-6902
  • Fax:
Mailing address:
  • Phone: 803-729-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: