Healthcare Provider Details

I. General information

NPI: 1730413634
Provider Name (Legal Business Name): EAST COOPER PSYCHIATRIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073B JOHNNIE DODDS BLVD SUITE 1 BUILDING F
MOUNT PLEASANT SC
29464-3155
US

IV. Provider business mailing address

1073B JOHNNIE DODDS BLVD SUITE 1 BUILDING F
MOUNT PLEASANT SC
29464-3155
US

V. Phone/Fax

Practice location:
  • Phone: 843-478-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number25547
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4478
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number18143
License Number StateSC

VIII. Authorized Official

Name: RICARDO JOSE FERMO
Title or Position: MEDICAL DOCTOR/ PSYCHIATRIST
Credential: MD
Phone: 843-478-8585