Healthcare Provider Details

I. General information

NPI: 1336355452
Provider Name (Legal Business Name): ALBERT JOSEPH BAROODY JR. DOCTOR OF MINISTRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S DARGAN ST
FLORENCE SC
29506-2534
US

IV. Provider business mailing address

252 S DARGAN ST
FLORENCE SC
29506-2534
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-0000
  • Fax: 843-669-9943
Mailing address:
  • Phone: 843-662-0000
  • Fax: 843-669-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1459
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: