Healthcare Provider Details

I. General information

NPI: 1558534677
Provider Name (Legal Business Name): MISS DANIELLE MCCLELLAN FIFIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BECKMAN RD
COLUMBIA SC
29203-3282
US

IV. Provider business mailing address

53 TOMMY CIR
COLUMBIA SC
29204-2735
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-8894
  • Fax: 803-754-8772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: