Provider Demographics
NPI:1790257178
Name:FELDER, PATRICE SYMONE
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:SYMONE
Last Name:FELDER
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 1:110 LULA BELL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29472-8818
Mailing Address - Country:US
Mailing Address - Phone:843-925-9503
Mailing Address - Fax:
Practice Address - Street 1:222 VARNFIELD DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7331
Practice Address - Country:US
Practice Address - Phone:843-925-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1616Medicaid