MEDICARE: PORTIA NEAT LPC-A

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	8099	SC

General Provider Information

NPI Number	:	1679432207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORTIA NEAT LPC-A

Provider Business Mailing Address
First Line	:	215 E BAY ST STE 201K
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29401-2635
Country	:	US
Telephone Number	:	843-779-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 W MONTAGUE AVE STE 201
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-6099
Country	:	US
Telephone Number	:	843-793-2104
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ PORTIA NEAT LPC-A” Practice Location

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