Provider Demographics
NPI:1811393747
Name:MERCER, AMANDA (MS, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:MS, LPC, LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 LANSFORD PL STE 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6979
Mailing Address - Country:US
Mailing Address - Phone:843-213-2659
Mailing Address - Fax:843-213-6231
Practice Address - Street 1:106 LANSFORD PL STE 202
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6979
Practice Address - Country:US
Practice Address - Phone:843-213-2659
Practice Address - Fax:843-213-6231
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7324101YP2500X
MDLC4376101YP2500X
SC7132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional