Provider Demographics
NPI:1700279254
Name:LOONEY, ROSA (LMFT, SIT,CC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LOONEY
Suffix:
Gender:F
Credentials:LMFT, SIT,CC
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:L
Other - Last Name:EDGINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT,SIT,CC
Mailing Address - Street 1:22 PARKCREST CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4456
Mailing Address - Country:US
Mailing Address - Phone:864-356-3184
Mailing Address - Fax:
Practice Address - Street 1:710 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3121
Practice Address - Country:US
Practice Address - Phone:864-356-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist