Healthcare Provider Details

I. General information

NPI: 1043081599
Provider Name (Legal Business Name): MEGAN TANNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LAFAYETTE CIR
GEORGETOWN SC
29440-2569
US

IV. Provider business mailing address

545 LAFAYETTE CIRCLE
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-6107
  • Fax:
Mailing address:
  • Phone: 843-904-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16502
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: