Individual
STACI RAE PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-CPS
Contact information
Practice address
2100 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5832
(843) 852-4100
Mailing address
2100 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5832
(843) 414-2351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10344
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760596480
—
SC
Enumeration date
04/30/2010
Last updated
03/19/2021
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