MEDICARE: JAMES ISLAND PRESBYTERIAN FOUNDATION

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	106H00000X	Marriage & Family Therapist
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1316257181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES ISLAND PRESBYTERIAN FOUNDATION

Provider Business Mailing Address
First Line	:	1632 FORT JOHNSON RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8822
Country	:	US
Telephone Number	:	843-795-3111
Fax Number	:	843-795-1508

Provider Business Practice Location Address
First Line	:	1632 FORT JOHNSON RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8822
Country	:	US
Telephone Number	:	843-795-3111
Fax Number	:	843-795-1508

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. HENRY JAY MEEUWSE
Credential	:	MA
Telephone Number	:	843-795-3111

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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