Provider Demographics
NPI:1407948250
Name:MEHALIC, DARIAN GLENN (LPC)
Entity Type:Individual
Prefix:
First Name:DARIAN
Middle Name:GLENN
Last Name:MEHALIC
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 WISE RD
Mailing Address - Street 2:P.O. BOX 136
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5521
Mailing Address - Country:US
Mailing Address - Phone:843-365-8884
Mailing Address - Fax:843-365-6685
Practice Address - Street 1:2404 WISE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5521
Practice Address - Country:US
Practice Address - Phone:843-365-8884
Practice Address - Fax:843-365-6685
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 5054101Y00000X
NCLPC 4930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102804Medicaid