Healthcare Provider Details

I. General information

NPI: 1861697856
Provider Name (Legal Business Name): MICHAEL KENNEDY PECOSH M.ED., NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PEARCE RD STE 4
BLUFFTON SC
29910-9353
US

IV. Provider business mailing address

39 PEARCE RD STE 4
BLUFFTON SC
29910-9353
US

V. Phone/Fax

Practice location:
  • Phone: 724-249-2829
  • Fax: 724-206-9222
Mailing address:
  • Phone: 724-249-2829
  • Fax: 724-206-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7981
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7981
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: