Provider Demographics
NPI:1417256785
Name:MCINERNY, MARY JO (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:MCINERNY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 PETTIGRU ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3121
Mailing Address - Country:US
Mailing Address - Phone:864-346-4866
Mailing Address - Fax:864-235-9508
Practice Address - Street 1:710 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3121
Practice Address - Country:US
Practice Address - Phone:864-346-4866
Practice Address - Fax:864-235-9508
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1956OtherAPS
SC1956OtherTRI-CARE