Provider Demographics
NPI:1275072316
Name:PATTERSON, CELISA ANN (MA, ADC, LPC)
Entity Type:Individual
Prefix:
First Name:CELISA
Middle Name:ANN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MA, ADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9027
Mailing Address - Country:US
Mailing Address - Phone:864-729-3081
Mailing Address - Fax:
Practice Address - Street 1:37 VILLA RD STE 206
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3040
Practice Address - Country:US
Practice Address - Phone:864-729-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8924101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty