Provider Demographics
NPI:1225290109
Name:ICHEP,LLC
Entity Type:Organization
Organization Name:ICHEP,LLC
Other - Org Name:INTERNATIONAL CONSULTANT FOR HEALTH AND EDUCATIONAL PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKA
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:I
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-477-7928
Mailing Address - Street 1:108 CAUGHMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:803-477-7928
Mailing Address - Fax:
Practice Address - Street 1:3555 HARDEN STREET EXT
Practice Address - Street 2:EXT., SUITE B18
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6894
Practice Address - Country:US
Practice Address - Phone:803-477-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20083300132079283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital