Provider Demographics
NPI:1457522658
Name:DR. MICHAEL NEBOSCHICK
Entity Type:Organization
Organization Name:DR. MICHAEL NEBOSCHICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEBOSCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-852-9016
Mailing Address - Street 1:838 PARAN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9046
Mailing Address - Country:US
Mailing Address - Phone:843-852-9016
Mailing Address - Fax:843-763-7246
Practice Address - Street 1:838 PARAN OAKS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9046
Practice Address - Country:US
Practice Address - Phone:843-852-9016
Practice Address - Fax:843-763-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC328251S00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service