Provider Demographics
NPI:1326324278
Name:BIEDA, MARY THERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:BIEDA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PLANTATION PARK DR
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6038
Mailing Address - Country:US
Mailing Address - Phone:843-290-6828
Mailing Address - Fax:
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:BUILDING 400
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6038
Practice Address - Country:US
Practice Address - Phone:843-290-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional