Provider Demographics
NPI:1265507719
Name:FREDERICK, ARLENE MAE (EDD, RN, LMBT)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:MAE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:EDD, RN, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7210L BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7973
Mailing Address - Country:US
Mailing Address - Phone:803-749-1576
Mailing Address - Fax:803-749-1676
Practice Address - Street 1:7210L BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7973
Practice Address - Country:US
Practice Address - Phone:803-749-1576
Practice Address - Fax:803-749-1676
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist