Healthcare Provider Details

I. General information

NPI: 1316257181
Provider Name (Legal Business Name): JAMES ISLAND PRESBYTERIAN FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 FORT JOHNSON RD
CHARLESTON SC
29412-8822
US

IV. Provider business mailing address

1632 FORT JOHNSON RD
CHARLESTON SC
29412-8822
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-3111
  • Fax: 843-795-1508
Mailing address:
  • Phone: 843-795-3111
  • Fax: 843-795-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY JAY MEEUWSE
Title or Position: DIRECTOR
Credential: MA
Phone: 843-795-3111