Healthcare Provider Details

I. General information

NPI: 1760185326
Provider Name (Legal Business Name): MORGAN EDNIE MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S BROAD ST
CLINTON SC
29325-2507
US

IV. Provider business mailing address

302 S BROAD ST
CLINTON SC
29325-2507
US

V. Phone/Fax

Practice location:
  • Phone: 864-923-5998
  • Fax:
Mailing address:
  • Phone: 864-923-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: