Healthcare Provider Details

I. General information

NPI: 1063407278
Provider Name (Legal Business Name): DARA ANITA JOSIAH-HOWZE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLEBOURNE ST SUITE 110
FORT MILL SC
29715
US

IV. Provider business mailing address

111 CLEBOURNE ST SUITE 110
FORT MILL SC
29715-1758
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-1301
  • Fax: 803-802-1303
Mailing address:
  • Phone: 803-802-1301
  • Fax: 803-802-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9901214
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01052673A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31489
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier314895
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: