Healthcare Provider Details

I. General information

NPI: 1275038531
Provider Name (Legal Business Name): ERIC JERROD MORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 AIRPORT DR
MONCKS CORNER SC
29461-2629
US

IV. Provider business mailing address

306 AIRPORT LANE
MONKSCORNER SC
29483
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: