Provider Demographics
NPI:1780089128
Name:MASSEY, JEREMY (LCMHC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MASSEY
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 MEADOW GLEN LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7486
Mailing Address - Country:US
Mailing Address - Phone:803-616-6587
Mailing Address - Fax:
Practice Address - Street 1:8801 J M KEYNES DR
Practice Address - Street 2:SUITE 440
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8436
Practice Address - Country:US
Practice Address - Phone:704-537-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11042101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health