Provider Demographics
NPI:1114977394
Name:LOEBS, TIMOTHY WILLIAM
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:LOEBS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:W
Other - Last Name:LOEBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:PO BOX 14452
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-4452
Mailing Address - Country:US
Mailing Address - Phone:843-650-8940
Mailing Address - Fax:843-651-5398
Practice Address - Street 1:1945 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4833
Practice Address - Country:US
Practice Address - Phone:843-650-8940
Practice Address - Fax:843-651-5398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional