Provider Demographics
NPI:1366825002
Name:HENRY, PATRICIA POLLOCK (LPC-I)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:POLLOCK
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:POLLOCK
Other - Last Name:YARDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC-I
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-0702
Mailing Address - Country:US
Mailing Address - Phone:864-643-6422
Mailing Address - Fax:
Practice Address - Street 1:25 ISELIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-1508
Practice Address - Country:US
Practice Address - Phone:864-643-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional