Provider Demographics
NPI:1134178874
Name:MASSEY, MARYANNE BANICH (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:BANICH
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 ASSEMBLY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2142
Mailing Address - Country:US
Mailing Address - Phone:803-254-4460
Mailing Address - Fax:803-771-7666
Practice Address - Street 1:2016 ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2142
Practice Address - Country:US
Practice Address - Phone:803-254-4460
Practice Address - Fax:803-771-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional