Frederick, Tasha Michelle

Frederick, Tasha Michelle is an individual health care provider with primary practice located at 1710 Trolley Rd Ste E , Summerville SC 29485-8281. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Frederick, Tasha Michelle can be contacted via phone (800) 552-4357.

Contact Information

Primary practice address
1710 Trolley Rd Ste E Summerville SC 29485-8281
Phone: (800) 552-4357
Fax: (678) 388-9244
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2005012030 Missouri
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149012282 Illinois
Behavioral Health & Social Service Providers / Clinical 1041C0700X 9309 South Carolina

Profile Details

NPI number 1215132733
LBN Legal business name Frederick, Tasha Michelle
Credentials LISW-CP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2007
Last updated Apr 8th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215132733 NPPES
South Carolina MEDICAID SW1054

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