Provider Demographics
NPI:1609118264
Name:FRASIER, COLISHA MARLENE (DCE, LPC, NCC, GCDF)
Entity Type:Individual
Prefix:DR
First Name:COLISHA
Middle Name:MARLENE
Last Name:FRASIER
Suffix:
Gender:F
Credentials:DCE, LPC, NCC, GCDF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 OLEANDER DR
Mailing Address - Street 2:SUITES # 1 & 2
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5738
Mailing Address - Country:US
Mailing Address - Phone:843-497-5240
Mailing Address - Fax:843-497-1129
Practice Address - Street 1:4603 OLEANDER DR
Practice Address - Street 2:SUITES # 1 & 2
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5738
Practice Address - Country:US
Practice Address - Phone:843-497-5240
Practice Address - Fax:843-497-1129
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3440101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor