MEDICARE: MERCY ME COUNSELING LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC7193	OTHER	SC	PROFESSIONAL LICENSE- COUNSELOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235785874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY ME COUNSELING LLC

Provider Business Mailing Address
First Line	:	716 ANDERSON ST STE B
Second Line	:
City	:	BELTON
State	:	SC
Zip	:	29627-2148
Country	:	US
Telephone Number	:	864-933-1447
Fax Number	:	800-340-0223

Provider Business Practice Location Address
First Line	:	716 ANDERSON ST STE B
Second Line	:
City	:	BELTON
State	:	SC
Zip	:	29627-2148
Country	:	US
Telephone Number	:	864-933-1447
Fax Number	:	800-340-0223

Authorized Official
Title or Position	:	OWNER
Name	:	SANDRA C LAWSON
Credential	:	LPC
Telephone Number	:	864-933-1447

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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