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General NPI Number Information
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NPI Number | 1720972219
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Entity Type | Organization
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Legal Business Name | PEACEFUL FOUNDATIONS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/07/2025
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 3255 LANDMARK DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-8461
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Country | US
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Telephone | 843-466-4420
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Fax | 843-989-0427
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Provider Business Mailing Address
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Address Line | 8211 PLEASANT RIDGE DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29420-8326
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Country | US
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Telephone | 803-543-3660
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Fax | 843-989-0427
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Authorized Official
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Title or Position | OWNER
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Name | TASHA M FREDERICK
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Credential | LISW-CP
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Telephone | 803-543-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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