Healthcare Provider Details

I. General information

NPI: 1003396458
Provider Name (Legal Business Name): BRIGETTE CUONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W MARTINTOWN RD
NORTH AUGUSTA SC
29841-3187
US

IV. Provider business mailing address

431 W MARTINTOWN RD
NORTH AUGUSTA SC
29841-3187
US

V. Phone/Fax

Practice location:
  • Phone: 706-691-9307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: