MEDICARE: GUIDED HEALING LICENSED CLINICAL THERAPY, 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	:	1790323582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDED HEALING LICENSED CLINICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	501 BELLE HALL PKWY UNIT 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8322
Country	:	US
Telephone Number	:	843-608-3552
Fax Number	:	843-823-3991

Provider Business Practice Location Address
First Line	:	501 BELLE HALL PKWY UNIT 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8322
Country	:	US
Telephone Number	:	843-225-0537
Fax Number	:	843-823-3991

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	SUSAN DURAND
Credential	:
Telephone Number	:	843-608-3552

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	11/25/2025

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