Provider Demographics
NPI:1184968448
Name:MCCOY, CHRISTOPHER (LISW-CP, CACII)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LISW-CP, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 BROAD RIVER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9686
Mailing Address - Country:US
Mailing Address - Phone:803-719-0488
Mailing Address - Fax:
Practice Address - Street 1:10415 BROAD RIVER RD
Practice Address - Street 2:SUITE F
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9686
Practice Address - Country:US
Practice Address - Phone:803-719-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1404045101YA0400X
SC91951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)