Healthcare Provider Details

I. General information

NPI: 1952256166
Provider Name (Legal Business Name): JOSHUA MARCENGILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E MONTAGUE AVE
NORTH CHARLESTON SC
29405-4716
US

IV. Provider business mailing address

4251 S RHETT AVE UNIT 6103
NORTH CHARLESTON SC
29405-6912
US

V. Phone/Fax

Practice location:
  • Phone: 803-753-1594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10823
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: