Provider Demographics
NPI:1639385065
Name:MIMI METCALFE, M.ED.
Entity Type:Organization
Organization Name:MIMI METCALFE, M.ED.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:B
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC
Authorized Official - Phone:864-654-7858
Mailing Address - Street 1:214 KEOWEE TRL
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1448
Mailing Address - Country:US
Mailing Address - Phone:864-654-7858
Mailing Address - Fax:864-654-7972
Practice Address - Street 1:214 KEOWEE TRL
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1448
Practice Address - Country:US
Practice Address - Phone:864-654-7858
Practice Address - Fax:864-654-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 1970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$OtherSSN
SC1821180092OtherNPI PERSONAL