Provider Demographics
NPI:1215369533
Name:BUCHANAN, HALLIE CLARK (LPC)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:CLARK
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:860 LOWCOUNTRY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3091
Mailing Address - Country:US
Mailing Address - Phone:843-790-4294
Mailing Address - Fax:
Practice Address - Street 1:860 LOWCOUNTRY BLVD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3091
Practice Address - Country:US
Practice Address - Phone:843-790-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health