MEDICARE: MRS. LISA MARIE BUTCHER GLAVIN MA, LPC, LPCS

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	6453	SC
2	101YP2500X	Professional Counselor	5225	SC

General Provider Information

NPI Number	:	1538478466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE BUTCHER GLAVIN MA, LPC, LPCS

Provider Business Mailing Address
First Line	:	710 JOHNNIE DODDS BLVD STE 200
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3045
Country	:	US
Telephone Number	:	843-800-1303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 STUART ENGALS BLVD STE 201
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7312
Country	:	US
Telephone Number	:	843-459-9805
Fax Number	:

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	08/23/2024

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