Healthcare Provider Details

I. General information

NPI: 1033289863
Provider Name (Legal Business Name): GLENN PETER ZAEPFEL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 EVELYN DR
COLUMBIA SC
29210-5212
US

IV. Provider business mailing address

409 EVELYN DR
COLUMBIA SC
29210-5212
US

V. Phone/Fax

Practice location:
  • Phone: 803-216-0850
  • Fax: 803-216-0420
Mailing address:
  • Phone: 803-216-0850
  • Fax: 803-216-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number456
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number488
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: