Provider Demographics
NPI:1770040073
Name:HOSSEINI, FARSHAD
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 PLEASANT RD # 11605
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7213
Mailing Address - Country:US
Mailing Address - Phone:877-293-7770
Mailing Address - Fax:
Practice Address - Street 1:105 STONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6489
Practice Address - Country:US
Practice Address - Phone:803-548-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator