Provider Demographics
NPI:1629123450
Name:SEVERSON, MARY ANN (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 TROTTERS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:863-414-7483
Mailing Address - Fax:863-314-9640
Practice Address - Street 1:430 WOODRUFF RD STE 450
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3443
Practice Address - Country:US
Practice Address - Phone:864-400-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALMHC39004878A101YM0800X
SCLPC9136101YM0800X
FLLMHC7711101YM0800X
FLMH7711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ050LOtherBCBS FL