Provider Demographics
NPI:1902143613
Name:SAFA, THARWAT ALI (EDS)
Entity type:Individual
Prefix:MISS
First Name:THARWAT
Middle Name:ALI
Last Name:SAFA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-0507
Mailing Address - Country:US
Mailing Address - Phone:803-484-5337
Mailing Address - Fax:803-483-0131
Practice Address - Street 1:310 ROLAND ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1140
Practice Address - Country:US
Practice Address - Phone:803-484-5337
Practice Address - Fax:803-483-0131
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool