Provider Demographics
NPI:1639774094
Name:CARD, PATRICIA KELLY (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KELLY
Last Name:CARD
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 1:3560 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5019
Mailing Address - Country:US
Mailing Address - Phone:954-451-7845
Mailing Address - Fax:
Practice Address - Street 1:113 EXECUTIVE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5681
Practice Address - Country:US
Practice Address - Phone:803-477-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty