Healthcare Provider Details

I. General information

NPI: 1720972219
Provider Name (Legal Business Name): PEACEFUL FOUNDATIONS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 LANDMARK DR
NORTH CHARLESTON SC
29418-8461
US

IV. Provider business mailing address

8211 PLEASANT RIDGE DR
NORTH CHARLESTON SC
29420-8326
US

V. Phone/Fax

Practice location:
  • Phone: 843-466-4420
  • Fax: 843-989-0427
Mailing address:
  • Phone: 803-543-3660
  • Fax: 843-989-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TASHA M FREDERICK
Title or Position: OWNER
Credential: LISW-CP
Phone: 803-543-3660