Provider Demographics
NPI:1447644331
Name:FERMO PSYCHIATRIC SOLUTIONS
Entity type:Organization
Organization Name:FERMO PSYCHIATRIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FERMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-442-6262
Mailing Address - Street 1:266 N SHELMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6609
Mailing Address - Country:US
Mailing Address - Phone:843-856-6998
Mailing Address - Fax:843-856-6997
Practice Address - Street 1:887 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3154
Practice Address - Country:US
Practice Address - Phone:843-856-6998
Practice Address - Fax:843-856-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT21081Medicaid
SCF96479Medicare UPIN