Provider Demographics
NPI:1245010834
Name:EMMOLO, LAUREN (LPSA, NCC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:EMMOLO
Suffix:
Gender:F
Credentials:LPSA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 COLEMAN BLVD UNIT 702
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4073
Mailing Address - Country:US
Mailing Address - Phone:843-849-4622
Mailing Address - Fax:
Practice Address - Street 1:222 W COLEMAN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3588
Practice Address - Country:US
Practice Address - Phone:843-849-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8595101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor