Healthcare Provider Details

I. General information

NPI: 1891193637
Provider Name (Legal Business Name): CLARICE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 BATTERY PARK RD
NESMITH SC
29580-3058
US

IV. Provider business mailing address

1453 BATTERY PARK RD
NESMITH SC
29580-3058
US

V. Phone/Fax

Practice location:
  • Phone: 843-372-5844
  • Fax: 843-382-4510
Mailing address:
  • Phone: 843-372-5844
  • Fax: 843-382-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: