Individual
CHANIQUA DESIREE MAZYCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
207 COMMERCE AVE, CHESTERFIELD, SC 29709
(843) 623-2229
Mailing address
P.O. BOX 918, 1035 CHERAW ST, BENNETTSVILLE, SC 29512
(843) 544-4098
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
08/15/2017
Last updated
08/15/2017
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