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NPI Code Detail

MEDICARE: PETER ZAWASKI CAC II

MEDICARE: PETER ZAWASKI CAC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1703288SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11703288OTHERSCSCAADAC

General Provider Information

NPI Number : 1053883249
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER ZAWASKI CAC II
Provider Business Mailing Address
First Line : 104 GEORGE BISHOP PKWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7335
Country : US
Telephone Number : 843-903-6212
Fax Number : 843-903-5432
Provider Business Practice Location Address
First Line : 104 GEORGE BISHOP PKWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7335
Country : US
Telephone Number : 843-903-6212
Fax Number : 843-903-5432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2018
Last Update Date : 12/28/2018

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