Provider Demographics
NPI:1073851846
Name:FRASIER, RICHARD A (CACII)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FRASIER
Suffix:
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 MARY HINES LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-4339
Mailing Address - Country:US
Mailing Address - Phone:843-527-3174
Mailing Address - Fax:
Practice Address - Street 1:2919 MARY HINES LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4339
Practice Address - Country:US
Practice Address - Phone:843-527-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1206142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1206142OtherCACII