Healthcare Provider Details

I. General information

NPI: 1396838249
Provider Name (Legal Business Name): JAMES E ZUKAUSKAS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601C MEETING STREET RD
N CHARLESTON SC
29405-7715
US

IV. Provider business mailing address

3601C MEETING STREET RD
N CHARLESTON SC
29405-7715
US

V. Phone/Fax

Practice location:
  • Phone: 843-740-6136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2806
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: