Provider Demographics
NPI:1033458211
Name:COHEN, WILLIE MAE (CACII)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:MAE
Last Name:COHEN
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GINN ALTMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-3962
Mailing Address - Country:US
Mailing Address - Phone:803-943-2800
Mailing Address - Fax:803-943-2267
Practice Address - Street 1:102 GINN ALTMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3962
Practice Address - Country:US
Practice Address - Phone:803-943-2800
Practice Address - Fax:803-943-2267
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1112302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)