Healthcare Provider Details

I. General information

NPI: 1184339061
Provider Name (Legal Business Name): CHERYL A MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HAZZARD CREEK VLG UNIT C
RIDGELAND SC
29936-8266
US

IV. Provider business mailing address

77 HAZZARD CREEK VLG UNIT C
RIDGELAND SC
29936-8266
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-7700
  • Fax: 888-908-7339
Mailing address:
  • Phone: 843-645-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: