Healthcare Provider Details

I. General information

NPI: 1699834143
Provider Name (Legal Business Name): MARK JOSEPH MEGLINO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 FISH HATCHERY RD
GASTON SC
29053-9038
US

IV. Provider business mailing address

301 PALMETTO PARK BLVD
LEXINGTON SC
29072-7872
US

V. Phone/Fax

Practice location:
  • Phone: 803-755-2261
  • Fax:
Mailing address:
  • Phone: 803-996-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: