Individual
KACEY IDOUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
58 UPPER POND RD, COLUMBIA, SC 29223-3054
(917) 660-1241
Mailing address
58 UPPER POND RD, COLUMBIA, SC 29223-3054
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/20/2024
Last updated
03/20/2024
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