Healthcare Provider Details

I. General information

NPI: 1639919293
Provider Name (Legal Business Name): HALEY BUZZETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 SUNNYSIDE DR
COLUMBIA SC
29204-3387
US

IV. Provider business mailing address

2079 ELMRIDGE RD
COLUMBIA SC
29209-4363
US

V. Phone/Fax

Practice location:
  • Phone: 803-445-3190
  • Fax:
Mailing address:
  • Phone: 803-553-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8720
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: