MEDICARE: LOWCOUNTRY THERAPY OF SC 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649733700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWCOUNTRY THERAPY OF SC LLC

Provider Business Mailing Address
First Line	:	119 KING CHARLES CIR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-3408
Country	:	US
Telephone Number	:	843-822-5837
Fax Number	:	855-435-6230

Provider Business Practice Location Address
First Line	:	208 W 7TH NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6621
Country	:	US
Telephone Number	:	843-557-2667
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. NICHOLAS KIERPIEC
Credential	:
Telephone Number	:	843-557-2667

Provider Enumeration Date	:	04/07/2019
Last Update Date	:	04/07/2019

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