Healthcare Provider Details

I. General information

NPI: 1063689594
Provider Name (Legal Business Name): CLERGY FOR EDUCATIONAL OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 BELLEVIEW ST 1105
COLUMBIA SC
29201-1839
US

IV. Provider business mailing address

1105 BELLEVIEW ST 1105
COLUMBIA SC
29201-1839
US

V. Phone/Fax

Practice location:
  • Phone: 803-462-4026
  • Fax:
Mailing address:
  • Phone: 803-462-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD L DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 803-462-4026