Provider Demographics
NPI:1326052150
Name:MASTERS, JOANNE MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-0022
Mailing Address - Country:US
Mailing Address - Phone:864-525-3624
Mailing Address - Fax:
Practice Address - Street 1:22 E INDIAN TRL
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5127
Practice Address - Country:US
Practice Address - Phone:864-525-3624
Practice Address - Fax:864-263-3230
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5116101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare ID - Type Unspecified