Healthcare Provider Details

I. General information

NPI: 1952931073
Provider Name (Legal Business Name): EMMA WORCZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W MONTAGUE AVE STE 201
NORTH CHARLESTON SC
29418-6099
US

IV. Provider business mailing address

3520 W MONTAGUE AVE STE 201
NORTH CHARLESTON SC
29418-6099
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-2104
  • Fax:
Mailing address:
  • Phone: 843-793-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9182
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: