MEDICARE: MRS. CYNTHIA ROARK MCKEEVER LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7545	OTHER	SC	LPC LICENSE #

General Provider Information

NPI Number	:	1093321150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA ROARK MCKEEVER LPC-S

Provider Business Mailing Address
First Line	:	2411 N OAK ST STE 403M
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3165
Country	:	US
Telephone Number	:	843-443-3172
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 N OAK ST STE 403M
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3165
Country	:	US
Telephone Number	:	843-443-3172
Fax Number	:	843-805-6563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	08/14/2024

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