Active NPI
Marcties Pendergrass
- Professional Counselor
- Florence, SC
National Provider Identifier
1720612500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7350
- Practice address
- 1800 2ND Loop Rd Ste 3
Florence, SC 29501-6180 - Phone
- (843) 667-1905
- Fax
- (843) 667-1723
- NPI assigned
- Mar 2, 2020
- Last updated
- Mar 2, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 7350 | SC | Primary |
Addresses
Primary practice location
1800 2ND Loop Rd Ste 3
Florence, SC 29501-6180
Mailing address
2928 Creek Rd
Lake City, SC 29560-6632
Phone (843) 550-7884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7350 | SC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583107200000",
"number": "1720612500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2928 CREEK RD",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295606632",
"telephone_number": "843-550-7884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 2ND LOOP RD STE 3",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295016180",
"telephone_number": "843-667-1905",
"fax_number": "843-667-1723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRASS",
"first_name": "MARCTIES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-02",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "7350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florence, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.