MEDICARE: MRS. CARRIE A COSTA MA, LPC

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	6143	SC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528299187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE A COSTA MA, LPC

Provider Business Mailing Address
First Line	:	935 PAULINE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4023
Country	:	US
Telephone Number	:	843-819-5070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 BARBADOS WAY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8649
Country	:	US
Telephone Number	:	843-819-5070
Fax Number	:

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

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	03/31/2026

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