Individual
FREDERICK P LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
200 PATEWOOD DR, SUITE A200, GREENVILLE, SC 29615-3593
(864) 454-5115
(864) 454-5146
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1086
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1305N
BLUE CROSS/BLUE SHIELD
NC
05
—
60-00266
—
NC
Enumeration date
08/22/2006
Last updated
02/28/2018
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