Healthcare Provider Details

I. General information

NPI: 1447644331
Provider Name (Legal Business Name): FERMO PSYCHIATRIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 JOHNNIE DODDS BLVD SUITE 100
MOUNT PLEASANT SC
29464-3154
US

IV. Provider business mailing address

266 N SHELMORE BLVD
MOUNT PLEASANT SC
29464-6609
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-6998
  • Fax: 843-856-6997
Mailing address:
  • Phone: 843-856-6998
  • Fax: 843-856-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOLI DAWN FERMO
Title or Position: OFFICE MANAGER
Credential: PHARMD
Phone: 843-442-6262