Healthcare Provider Details

I. General information

NPI: 1043017072
Provider Name (Legal Business Name): SAVANNAH E MIKELL MS, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNAH E MAULDIN BA

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 DICK POND RD STE E
MYRTLE BEACH SC
29588-6810
US

IV. Provider business mailing address

4325 DICK POND RD STE E
MYRTLE BEACH SC
29588-6810
US

V. Phone/Fax

Practice location:
  • Phone: 843-900-7641
  • Fax:
Mailing address:
  • Phone: 843-900-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCOU.10299
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: