Provider Demographics
NPI:1023492287
Name:MCPHERSON, SHAMIQUIA N (MA, LPC-S CANDIDATE)
Entity type:Individual
Prefix:MS
First Name:SHAMIQUIA
Middle Name:N
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MA, LPC-S CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SOFT STONE DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8176
Mailing Address - Country:US
Mailing Address - Phone:803-888-9058
Mailing Address - Fax:803-724-6758
Practice Address - Street 1:1627 AUBURN ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-888-9058
Practice Address - Fax:803-724-6758
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1668Medicaid
SC435201Medicaid