Healthcare Provider Details

I. General information

NPI: 1164687810
Provider Name (Legal Business Name): MARY LYNN MUCK L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY LYNN MUCK LPC

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SWEENEY DR
LITTLE RIVER SC
29566-8587
US

IV. Provider business mailing address

813 SWEENEY DR
LITTLE RIVER SC
29566-8587
US

V. Phone/Fax

Practice location:
  • Phone: 301-466-9900
  • Fax:
Mailing address:
  • Phone: 301-466-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5581
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: