Healthcare Provider Details

I. General information

NPI: 1265230726
Provider Name (Legal Business Name): PAMELA PHELAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BEN SAWYER BLVD STE D15
MOUNT PLEASANT SC
29464-4591
US

IV. Provider business mailing address

219 ASHMONT DR
CHARLESTON SC
29492-7812
US

V. Phone/Fax

Practice location:
  • Phone: 201-341-5338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12250
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: