Healthcare Provider Details

I. General information

NPI: 1053642124
Provider Name (Legal Business Name): MEGAN KATHLEEN MAHONEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 TOBIAS GADSON BLVD SUITE 107
CHARLESTON SC
29407-8702
US

IV. Provider business mailing address

1483 TOBIAS GADSON BLVD SUITE 107
CHARLESTON SC
29407-8702
US

V. Phone/Fax

Practice location:
  • Phone: 843-745-5153
  • Fax: 843-766-8606
Mailing address:
  • Phone: 843-745-5153
  • Fax: 843-766-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5071
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: