Provider Demographics
NPI:1497380950
Name:TREJO, MARCIA M (LPC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:M
Last Name:TREJO
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 1:209 HAYWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7104
Mailing Address - Country:US
Mailing Address - Phone:803-243-4003
Mailing Address - Fax:
Practice Address - Street 1:209 HAYWORTH RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7104
Practice Address - Country:US
Practice Address - Phone:803-243-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4111101YM0800X
CT005213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC435201Medicaid