Provider Demographics
NPI:1073742805
Name:MENDEZ, LORAINE JEANNE (MA, CPSY)
Entity Type:Individual
Prefix:MS
First Name:LORAINE
Middle Name:JEANNE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MA, CPSY
Other - Prefix:
Other - First Name:LORAINE
Other - Middle Name:JEANNE
Other - Last Name:GARAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CPSY
Mailing Address - Street 1:182 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-2651
Mailing Address - Country:US
Mailing Address - Phone:843-205-9461
Mailing Address - Fax:
Practice Address - Street 1:182 GLENMOOR DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-2651
Practice Address - Country:US
Practice Address - Phone:843-205-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health