Provider Demographics
NPI:1154871135
Name:FETTERHOFF, CHELSEA (EDS, NCC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:FETTERHOFF
Suffix:
Gender:F
Credentials:EDS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4738
Mailing Address - Country:US
Mailing Address - Phone:803-432-6902
Mailing Address - Fax:803-432-6890
Practice Address - Street 1:709 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4738
Practice Address - Country:US
Practice Address - Phone:803-432-6902
Practice Address - Fax:803-432-6890
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional