Provider Demographics
NPI:1891364808
Name:SOPER, MICHAELA BYRNE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:BYRNE
Last Name:SOPER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SWEET THORNE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8234
Mailing Address - Country:US
Mailing Address - Phone:978-882-2986
Mailing Address - Fax:
Practice Address - Street 1:821 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2305
Practice Address - Country:US
Practice Address - Phone:978-882-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health