MEDICARE: TERRI SOUTHARD MS, 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	101YP2500X	Professional Counselor	2264	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952706475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI SOUTHARD MS, LPC

Provider Business Mailing Address
First Line	:	2384 RICE POND RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-6575
Country	:	US
Telephone Number	:	843-894-4089
Fax Number	:	843-970-2383

Provider Business Practice Location Address
First Line	:	5133 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6338
Country	:	US
Telephone Number	:	843-789-1786
Fax Number	:	843-958-1263

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	06/24/2026

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