Healthcare Provider Details

I. General information

NPI: 1013071802
Provider Name (Legal Business Name): JANET ROSE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E BAY ST SUITE 501
CHARLESTON SC
29401-2633
US

IV. Provider business mailing address

215 E BAY ST SUITE 501
CHARLESTON SC
29401-2633
US

V. Phone/Fax

Practice location:
  • Phone: 843-708-4308
  • Fax: 843-723-8324
Mailing address:
  • Phone: 843-708-4308
  • Fax: 843-723-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number362
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: