MEDICARE: MRS. ANN C MCDONALD LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5371	SC
2	101YM0800X	Mental Health Counselor	5371	SC

General Provider Information

NPI Number	:	1194977538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN C MCDONALD LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 71078
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-0036
Country	:	US
Telephone Number	:	843-855-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 PROFESSIONAL DR
Second Line	:	SUITE D, #202
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	843-855-6180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	06/23/2015

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