Healthcare Provider Details

I. General information

NPI: 1750916904
Provider Name (Legal Business Name): MRS. MELISSA DACAMARA HICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 S LAKE DR
LEXINGTON SC
29073-3720
US

IV. Provider business mailing address

2711 COLONIAL DR
COLUMBIA SC
29203-6818
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: