Healthcare Provider Details

I. General information

NPI: 1548606072
Provider Name (Legal Business Name): YOUNG WOMEN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 LANDMARK DR SUITE 102
NORTH CHARLESTON SC
29418-8576
US

IV. Provider business mailing address

3262 LANDMARK DR SUITE 102
NORTH CHARLESTON SC
29418-8576
US

V. Phone/Fax

Practice location:
  • Phone: 843-901-8712
  • Fax:
Mailing address:
  • Phone: 843-901-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVON V WIGFALL
Title or Position: DIRECTOR
Credential:
Phone: 843-901-8712