Provider Demographics
NPI:1346931144
Name:MCCOY, JEREMY R (LMSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5442
Mailing Address - Country:US
Mailing Address - Phone:803-646-1723
Mailing Address - Fax:
Practice Address - Street 1:105 SUMMERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7713
Practice Address - Country:US
Practice Address - Phone:803-753-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker