Healthcare Provider Details

I. General information

NPI: 1114256807
Provider Name (Legal Business Name): JANA-MARIE T RISCH LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 BOWMAN RD STE 104
MOUNT PLEASANT SC
29464-3235
US

IV. Provider business mailing address

2151 WESTRIVERS RD
CHARLESTON SC
29412-2092
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-2535
  • Fax:
Mailing address:
  • Phone: 843-718-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10451
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: