Individual
MICAH FORDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3739 OAKLEAF RD APT A, COLUMBIA, SC 29206-5202
(803) 638-2786
Mailing address
3713 COVENANT RD, COLUMBIA, SC 29204-4217
(888) 753-0009
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9888
SC
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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