Healthcare Provider Details

I. General information

NPI: 1679709984
Provider Name (Legal Business Name): JOAN N MCMAHON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 2ND AVE UNIT G
CONWAY SC
29526-5215
US

IV. Provider business mailing address

1312 2ND AVE UNIT G
CONWAY SC
29526-5215
US

V. Phone/Fax

Practice location:
  • Phone: 802-505-1048
  • Fax:
Mailing address:
  • Phone: 802-505-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0047953
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10992
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: