MEDICARE: DR. JAMES FURTICK JR. PH.D

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
1	101YP2500X	Professional Counselor	4068	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265441265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES FURTICK JR. PH.D

Provider Business Mailing Address
First Line	:	108 STAGE COACH LANE
Second Line	:	VILLAGE PARK
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-2499
Country	:	US
Telephone Number	:	803-516-0200
Fax Number	:	803-516-8288

Provider Business Practice Location Address
First Line	:	108 STAGE COACH LANE
Second Line	:	VILLAGE PARK
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-2499
Country	:	US
Telephone Number	:	803-516-0200
Fax Number	:	803-516-8288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/24/2023

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