Provider Demographics
NPI:1821414657
Name:CARR, MANDY MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:MICHELLE
Last Name:CARR
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 1:3896 LEEDS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7479
Mailing Address - Country:US
Mailing Address - Phone:843-642-7572
Mailing Address - Fax:843-405-1325
Practice Address - Street 1:3896 LEEDS AVE STE 202
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7479
Practice Address - Country:US
Practice Address - Phone:843-642-7572
Practice Address - Fax:843-405-1325
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12060101YM0800X
SC6638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health