Provider Demographics
NPI:1497086110
Name:MARY ANN MCGANNON, LPC, LLC
Entity Type:Organization
Organization Name:MARY ANN MCGANNON, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-431-6103
Mailing Address - Street 1:770 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-5708
Mailing Address - Country:US
Mailing Address - Phone:803-431-6103
Mailing Address - Fax:
Practice Address - Street 1:1122 SAM NEWELL RD
Practice Address - Street 2:STE 103
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5015
Practice Address - Country:US
Practice Address - Phone:803-431-6103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2816101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty