Healthcare Provider Details

I. General information

NPI: 1407303522
Provider Name (Legal Business Name): HAMOLIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 TROLLEY RD
SUMMERVILLE SC
29485-5203
US

IV. Provider business mailing address

107 SHENANDOAH CT
SUMMERVILLE SC
29485-5013
US

V. Phone/Fax

Practice location:
  • Phone: 843-821-2480
  • Fax:
Mailing address:
  • Phone: 843-270-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAPN113
License Number StateSC

VIII. Authorized Official

Name: MS. CHRISTINE DIANE HAMOLIA
Title or Position: OWNER
Credential: APRN
Phone: 843-270-5767