Provider Demographics
NPI:1174902332
Name:SMALLS, NEFATERI
Entity type:Individual
Prefix:
First Name:NEFATERI
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NEFATERI
Other - Middle Name:
Other - Last Name:PECOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29472-0231
Mailing Address - Country:US
Mailing Address - Phone:843-879-2255
Mailing Address - Fax:
Practice Address - Street 1:118 BOBBY DRIVE
Practice Address - Street 2:
Practice Address - City:RIDGEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29472-0231
Practice Address - Country:US
Practice Address - Phone:843-296-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral