MEDICARE: CHARLESTON WOMEN'S THERAPY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336098573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON WOMEN'S THERAPY

Provider Business Mailing Address
First Line	:	1419 RIVER FRONT DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-3609
Country	:	US
Telephone Number	:	843-371-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CARRIAGE LN STE 102
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6060
Country	:	US
Telephone Number	:	843-310-0740
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JACEY VERDICCHIO
Credential	:	LPC
Telephone Number	:	843-371-4479

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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