Provider Demographics
NPI:1033139506
Name:ZAHNISER, PATRICIA A (LISW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:ZAHNISER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E COAST LN
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2985
Mailing Address - Country:US
Mailing Address - Phone:843-655-9438
Mailing Address - Fax:843-281-4185
Practice Address - Street 1:2208 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4267
Practice Address - Country:US
Practice Address - Phone:843-655-9438
Practice Address - Fax:843-281-4185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8544101YA0400X, 101YM0800X, 1041C0700X
PACW0128431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ340640281Medicare ID - Type Unspecified