Healthcare Provider Details

I. General information

NPI: 1710081153
Provider Name (Legal Business Name): NANCY CAMPBELL MAHIDA LPC, LPC-S, CACII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY C. MAHIDA M.ED., LPC, LPC-S

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 HUMAN SERVICES RD
CLINTON SC
29325-7548
US

IV. Provider business mailing address

219 HUMAN SERVICES RD
CLINTON SC
29325-7548
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-6500
  • Fax: 864-833-6905
Mailing address:
  • Phone: 864-833-6500
  • Fax: 864-833-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2382
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5223
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCERT # 12122110
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: