Provider Demographics
NPI:1093765943
Name:MYERS, LINDA SELENA (DCC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SELENA
Last Name:MYERS
Suffix:
Gender:F
Credentials:DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-1230
Mailing Address - Country:US
Mailing Address - Phone:843-900-1072
Mailing Address - Fax:803-494-1530
Practice Address - Street 1:1744 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-1230
Practice Address - Country:US
Practice Address - Phone:843-900-1072
Practice Address - Fax:803-494-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5231101Y00000X
FLTPMC2417101YM0800X
WALH61331189101YM0800X
IDLCPC9188101YP2500X
ORC6693101YP2500X
GALPC007949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1152Medicaid
SC5304OtherLICENSED PROFESSIONAL COUNSELOR SUPERVISOR
SC5231OtherLICENSED PROFESSIONAL COUNSELOR