Healthcare Provider Details

I. General information

NPI: 1225243835
Provider Name (Legal Business Name): DOUGLAS FOTIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326 MEDICAL PLAZA DR STE A
NORTH CHARLESTON SC
29406-9138
US

IV. Provider business mailing address

9326 MEDICAL PLAZA DR STE A
NORTH CHARLESTON SC
29406-9138
US

V. Phone/Fax

Practice location:
  • Phone: 843-377-1600
  • Fax: 843-377-1601
Mailing address:
  • Phone: 843-377-1600
  • Fax: 843-377-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6167
License Number StateSC

VIII. Authorized Official

Name: DOUGLAS FOTIA
Title or Position: PRESIDENT
Credential: LISW-CP
Phone: 843-412-3300