MEDICARE: DR. COLISHA MARLENE FRASIER DCE, LPC, NCC, GCDF

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	101Y00000X	Counselor	3440	SC

General Provider Information

NPI Number	:	1609118264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLISHA MARLENE FRASIER DCE, LPC, NCC, GCDF

Provider Business Mailing Address
First Line	:	4603 OLEANDER DR
Second Line	:	SUITES # 1 & 2
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5738
Country	:	US
Telephone Number	:	843-497-5240
Fax Number	:	843-497-1129

Provider Business Practice Location Address
First Line	:	4603 OLEANDER DR
Second Line	:	SUITES # 1 & 2
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5738
Country	:	US
Telephone Number	:	843-497-5240
Fax Number	:	843-497-1129

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/21/2013

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