Healthcare Provider Details

I. General information

NPI: 1346501095
Provider Name (Legal Business Name): MICHAEL JAMES STOLARIK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COMMERCE AVE
CHESTERFIELD SC
29769
US

IV. Provider business mailing address

PO BOX 918
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-623-2229
  • Fax:
Mailing address:
  • Phone: 843-544-4098
  • 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: