Healthcare Provider Details

I. General information

NPI: 1588965511
Provider Name (Legal Business Name): JAMES H. MOODY JR. LPCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 OLD TROLLEY RD STE A
SUMMERVILLE SC
29485-5673
US

IV. Provider business mailing address

627 OLD TROLLEY RD STE A
SUMMERVILLE SC
29485-5673
US

V. Phone/Fax

Practice location:
  • Phone: 800-552-4357
  • Fax: 678-388-9244
Mailing address:
  • Phone: 800-552-4357
  • Fax: 678-388-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5770
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8103
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: