Provider Demographics
NPI:1720001571
Name:WARREN, MACK MILES (LPC)
Entity Type:Individual
Prefix:MR
First Name:MACK
Middle Name:MILES
Last Name:WARREN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1321 LADY STREET, FIRST FLOOR
Mailing Address - Street 2:PALMETTO HEALTH
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2525
Practice Address - Street 1:1330 TAYLOT AT MARION ST
Practice Address - Street 2:PALMETTO BAPTIST COUNSELING CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:803-296-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional