Provider Demographics
NPI:1013958826
Name:MCGEORGE, SHELLEY ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNE
Last Name:MCGEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 RICHLAND ST STE B101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2357
Mailing Address - Country:US
Mailing Address - Phone:803-771-0002
Mailing Address - Fax:
Practice Address - Street 1:914 RICHLAND ST
Practice Address - Street 2:SUITE 201B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2357
Practice Address - Country:US
Practice Address - Phone:803-252-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC442101Y00000X
SC1654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor