Healthcare Provider Details

I. General information

NPI: 1699894113
Provider Name (Legal Business Name): HARRIET ANNETTE ROSE MASTER OF ART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N MATTHEWS RD
LAKE CITY SC
29560-7027
US

IV. Provider business mailing address

125 E CHEVES ST
FLORENCE SC
29506-2526
US

V. Phone/Fax

Practice location:
  • Phone: 843-394-7600
  • Fax: 843-661-4892
Mailing address:
  • Phone: 843-317-4089
  • Fax: 843-317-4096

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: