Provider Demographics
NPI:1609043132
Name:MYERS, STEPHANIE SUE (LPES)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 RIVERS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4650
Mailing Address - Country:US
Mailing Address - Phone:843-637-4211
Mailing Address - Fax:843-793-3691
Practice Address - Street 1:7301 RIVERS AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-637-4211
Practice Address - Fax:843-793-3691
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC4698103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor