Coleman J Connolly, MFT
Individual provider Active NPI Marriage & Family Therapist · Charleston, SC
NPI 1780910752 · NPPES record last updated Jul 14, 2024
Key facts
- NPI
- 1780910752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 6967 (SC)
- Practice address
- 171 Ashley Ave
Charleston, SC 29425-3591 - Phone
- (843) 792-1414
- NPI assigned
- Oct 27, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- University Medical Associates of the Medical University of South Carol
Practice addresses (Care Compare)
171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414
Hospital & facility affiliations
- Musc Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240815003464 | SC | Practitioner - Mental Health Counselor | 6002354453 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 182 | HI | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Medical Associates of the Medical University of South Carol | Marriage & Family Therapist | Current |
Accepting new patients |
| University Medical Associates of the Medical University of South Carol | Current | Accepting new patients | |
| University Medical Associates of the Medical University of South Carol | Current |
Accepting new patients |
Locations
171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123
67 President St
Charleston, SC 29425
Phone (843) 792-0192
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 182 | HI | |
| Marriage & Family Therapist | 106H00000X | 6967 | SC | Yes |
Addresses
Primary practice location
171 Ashley Ave
Charleston, SC 29425-3591
Mailing address
67 President St
Charleston, SC 29425-5712
Phone (843) 792-1414
Other practice location 1
222 W Coleman Blvd Ste 106
Mount Pleasant, SC 29464-3591
Phone (808) 373-6212
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | direct@direct.musc.edu | Health Information Exchange (HIE) |
Other providers in Charleston, SC
- Olivia Louise Conn
- Abby C Connell
- Kimberly McClure Connell
- James Edwin Connelly
- Ruth S Conner
- Ryan John Connolly
- Nicholas John Connors
- Emma Claire Conover
- Juliana Nicole Conover
- Jasen Conrad
All providers in Charleston, SC · Marriage & Family Therapist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.