Provider Demographics
NPI:1902822679
Name:MISHOE, CATHERINE M (MA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:MISHOE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:MISHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4026 LAMAR ST # 3894
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5784
Mailing Address - Country:US
Mailing Address - Phone:843-254-5515
Mailing Address - Fax:
Practice Address - Street 1:4026 LAMAR ST # 3894
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5784
Practice Address - Country:US
Practice Address - Phone:843-254-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC5283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional