Provider Demographics
NPI:1093730632
Name:SLOAN, THERESA ELISE (MED LPC LAC CCMHC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ELISE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MED LPC LAC CCMHC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ELISE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 LANSFORD CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-3501
Mailing Address - Country:US
Mailing Address - Phone:843-983-1655
Mailing Address - Fax:843-983-1665
Practice Address - Street 1:106 LANSFORD CT STE 200
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-3501
Practice Address - Country:US
Practice Address - Phone:843-983-1655
Practice Address - Fax:843-983-1665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
SC3750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional