Healthcare Provider Details

I. General information

NPI: 1740192525
Provider Name (Legal Business Name): MARIELENA DIMATTEO LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CLARK SUMMIT DR STE 100
BLUFFTON SC
29910-4992
US

IV. Provider business mailing address

276 STATION PKWY
BLUFFTON SC
29910-9516
US

V. Phone/Fax

Practice location:
  • Phone: 843-640-5362
  • Fax:
Mailing address:
  • Phone: 843-640-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10627
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: