Healthcare Provider Details

I. General information

NPI: 1972643658
Provider Name (Legal Business Name): JOAN ROST MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR COTTAGE A
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

1313 FRIARSGATE BLVD
IRMO SC
29063-2183
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1855
  • Fax:
Mailing address:
  • Phone: 803-732-7930
  • 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: