Provider Demographics
NPI:1649518077
Name:MAGUIRE, LIZA MARIE (SSP, LPES)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:MARIE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:SSP, LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-1534
Mailing Address - Country:US
Mailing Address - Phone:843-623-5502
Mailing Address - Fax:843-623-3434
Practice Address - Street 1:401 WEST BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-1534
Practice Address - Country:US
Practice Address - Phone:843-623-5502
Practice Address - Fax:843-623-3434
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4571103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool