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General NPI Number Information
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NPI Number | 1376097220
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Entity Type | Individual
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Provider Name | MICHAEL TRUESDALE
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Gender | Male
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 8251 CHATSWORTH DR
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City | FORT MILL
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State | SC
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Zip | 29707-1571
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Country | US
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Telephone | 803-320-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 8251 CHATSWORTH DR
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City | FORT MILL
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State | SC
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Zip | 29707-1571
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Country | US
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Telephone | 803-320-2064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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