Healthcare Provider Details

I. General information

NPI: 1942644539
Provider Name (Legal Business Name): DANA RAE COCKFIELD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MCMILLIAN LN
FLORENCE SC
29506-3428
US

IV. Provider business mailing address

1400 MCMILLIAN LN
FLORENCE SC
29506-3428
US

V. Phone/Fax

Practice location:
  • Phone: 843-664-8457
  • Fax: 843-664-8462
Mailing address:
  • Phone: 843-664-8457
  • Fax: 843-664-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: