Provider Demographics
NPI:1578968988
Name:PUGH, PSHANDA CHANTE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:PSHANDA
Middle Name:CHANTE
Last Name:PUGH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 DUNRAVEN CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-3170
Mailing Address - Country:US
Mailing Address - Phone:843-283-4789
Mailing Address - Fax:
Practice Address - Street 1:1208 DUNRAVEN CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-3170
Practice Address - Country:US
Practice Address - Phone:843-283-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9172101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor