Healthcare Provider Details

I. General information

NPI: 1396005013
Provider Name (Legal Business Name): DORETHA FRIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LAFAYETTE CIR
GEORGETOWN SC
29440-2569
US

IV. Provider business mailing address

525 LAFAYETTE CIR
GEORGETOWN SC
29440-2569
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-6107
  • Fax: 843-527-2800
Mailing address:
  • Phone: 843-546-6107
  • Fax: 843-527-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: