Provider Demographics
NPI:1790113447
Name:MCCARRELL, RONNIE (LPC)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:MCCARRELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CLIMBING ROSE CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-3514
Mailing Address - Country:US
Mailing Address - Phone:864-520-4476
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD
Practice Address - Street 2:SUITE 412
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6125
Practice Address - Country:US
Practice Address - Phone:864-553-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12389770OtherCAQH
SCPC1108Medicaid