Provider Demographics
NPI:1053642124
Name:MAHONEY, MEGAN KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8702
Mailing Address - Country:US
Mailing Address - Phone:843-745-5153
Mailing Address - Fax:843-766-8606
Practice Address - Street 1:1483 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-8702
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:843-766-8606
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health