Provider Demographics
NPI:1295067270
Name:MCCARTHY, WESLEY ALAN (LPC)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALAN
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-2745
Mailing Address - Country:US
Mailing Address - Phone:803-335-3380
Mailing Address - Fax:803-663-1759
Practice Address - Street 1:114 EAST HALL STREET
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:GA
Practice Address - Zip Code:30824
Practice Address - Country:US
Practice Address - Phone:706-597-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional