MEDICARE: RICHARD JAMES STOLTZ LISW-CP SC 14656

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	1041C0700X	Clinical Social Worker	14656	SC

General Provider Information

NPI Number	:	1366616567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JAMES STOLTZ LISW-CP SC 14656

Provider Business Mailing Address
First Line	:	4000 FABER PLACE DR STE 110
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8585
Country	:	US
Telephone Number	:	843-501-1099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 110
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8585
Country	:	US
Telephone Number	:	843-501-1099
Fax Number	:

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	08/01/2022

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