Healthcare Provider Details

I. General information

NPI: 1114067683
Provider Name (Legal Business Name): SANDRA CUOCO LMFT,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 RAILROAD AVE
RIDGELAND SC
29936-2623
US

IV. Provider business mailing address

60 RAILROAD AVE
RIDGELAND SC
29936-2623
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-7700
  • Fax: 188-890-8733
Mailing address:
  • Phone: 843-645-7700
  • Fax: 188-890-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000993
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4530
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: