Provider Demographics
NPI:1477119865
Name:MIRACLE, ANNE E (LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:MIRACLE
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 1:100-A CENTRAL AVE SUITE 203
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445
Mailing Address - Country:US
Mailing Address - Phone:843-892-9414
Mailing Address - Fax:877-780-1103
Practice Address - Street 1:100 CENTRAL AVE STE 203A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2979
Practice Address - Country:US
Practice Address - Phone:843-892-9414
Practice Address - Fax:877-780-1103
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty