Provider Demographics
NPI:1518477520
Name:IVEY, LORI ANN (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:IVEY
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 1:127 METRO DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2789
Mailing Address - Country:US
Mailing Address - Phone:864-397-8056
Mailing Address - Fax:
Practice Address - Street 1:127 METRO DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2789
Practice Address - Country:US
Practice Address - Phone:864-397-8056
Practice Address - Fax:864-484-8225
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1868Medicaid