Provider Demographics
NPI:1992025738
Name:ROYCROFT, MICHAEL ALAN (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:ROYCROFT
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MILLSTONE RD APT X
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3954
Mailing Address - Country:US
Mailing Address - Phone:843-610-3069
Mailing Address - Fax:843-407-1888
Practice Address - Street 1:656 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5255
Practice Address - Country:US
Practice Address - Phone:843-610-3069
Practice Address - Fax:843-407-1888
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional