Provider Demographics
NPI:1205973344
Name:MCQUAGE, MARY ROSS (LISW-CP)
Entity type:Individual
Prefix:
First Name:MARY ROSS
Middle Name:
Last Name:MCQUAGE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-9607
Mailing Address - Country:US
Mailing Address - Phone:843-224-3231
Mailing Address - Fax:
Practice Address - Street 1:20 LAVINGTON RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-9607
Practice Address - Country:US
Practice Address - Phone:843-224-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical