MEDICARE: TERRI MCCREA

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	2580	SC

General Provider Information

NPI Number	:	1124140140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI MCCREA

Provider Business Mailing Address
First Line	:	1836 ASHLEY RIVER RD
Second Line	:	SUITE 113
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1744 SAM RITTENBERG BLVD STE C
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4942
Country	:	US
Telephone Number	:	843-556-3443
Fax Number	:	843-763-7202

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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