Healthcare Provider Details

I. General information

NPI: 1932019866
Provider Name (Legal Business Name): HAILEY ILYSSA LAPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8084 RIVERS AVE
NORTH CHARLESTON SC
29406-9235
US

IV. Provider business mailing address

PO BOX 118006
NORTH CHARLESTON SC
29423-8006
US

V. Phone/Fax

Practice location:
  • Phone: 843-628-3000
  • Fax: 843-574-8239
Mailing address:
  • Phone: 843-628-3000
  • Fax: 843-574-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19106
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: