Provider Demographics
NPI:1629074604
Name:STOLLER, HELENE F
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:F
Last Name:STOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LITTLE JOHNS RETREAT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5705
Mailing Address - Country:US
Mailing Address - Phone:843-290-6828
Mailing Address - Fax:843-757-6289
Practice Address - Street 1:23 PLANTATION PARK RD
Practice Address - Street 2:BLDG 400
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9009
Practice Address - Country:US
Practice Address - Phone:843-290-6828
Practice Address - Fax:843-757-3993
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ342170281Medicare PIN