MEDICARE: AMANDA MERCER MS, LPC, LCPC

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	LPC7324	SD
2	101YP2500X	Professional Counselor	LC4376	MD
3	101YP2500X	Professional Counselor	7132	SC

General Provider Information

NPI Number	:	1811393747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MERCER MS, LPC, LCPC

Provider Business Mailing Address
First Line	:	106 LANSFORD PL STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-213-2659
Fax Number	:	843-213-6231

Provider Business Practice Location Address
First Line	:	106 LANSFORD PL STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-213-2659
Fax Number	:	843-213-6231

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	12/09/2019

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