Provider Demographics
NPI:1811203441
Name:AHEARN, NADEIJE RITA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:NADEIJE
Middle Name:RITA
Last Name:AHEARN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4184
Mailing Address - Country:US
Mailing Address - Phone:843-661-6030
Mailing Address - Fax:
Practice Address - Street 1:1803 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4184
Practice Address - Country:US
Practice Address - Phone:843-661-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC5628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health