Provider Demographics
NPI:1366147167
Name:RADZISZEWSKA-PETROS, MALGORZATA EWA (NCAC II, AADC, CADC)
Entity type:Individual
Prefix:MRS
First Name:MALGORZATA
Middle Name:EWA
Last Name:RADZISZEWSKA-PETROS
Suffix:
Gender:F
Credentials:NCAC II, AADC, CADC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:RADZISZEWSKA-PETROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCAC II, AADC, CADC
Mailing Address - Street 1:897 TYNE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5010
Mailing Address - Country:US
Mailing Address - Phone:864-430-2415
Mailing Address - Fax:
Practice Address - Street 1:897 TYNE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-5010
Practice Address - Country:US
Practice Address - Phone:864-430-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)