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General NPI Number Information
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NPI Number | 1851561393
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Entity Type | Individual
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Provider Name | WILLIAM MARK FREDERICK MA
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Gender | Male
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 214 KEOWEE TRL
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City | CLEMSON
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State | SC
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Zip | 29631-1448
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Country | US
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Telephone | 864-367-9023
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Fax |
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Provider Business Mailing Address
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Address Line | 106 BROOKSTONE WAY
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City | CENTRAL
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State | SC
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Zip | 29630-3604
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Country | US
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Telephone | 864-367-9023
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 30357
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4564
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License Number State | SC
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