NPIMap

Organization Active NPI

Lakeside Family Center

  • Mental Health Counselor
  • Moncks Corner, SC
National Provider Identifier
1902177520
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4776 Issued in SC
Legal business name
LAKESIDE FAMILY CENTER
Practice address
219 N Highway 52
Ste R
Moncks Corner, SC 29461-3926
Phone
(843) 761-3325
NPI assigned
Jan 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elizabeth Louise Vinson, MA, LPCNPI 1619915055
Title
Owner
Phone
(843) 761-3325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 4776 SC Primary

Addresses

Primary practice location

219 N Highway 52
Ste R
Moncks Corner, SC 29461-3926

Mailing address

219 N Highway 52
Ste R
Moncks Corner, SC 29461-3926
Phone (843) 761-3325

National Provider Directory

National Provider Directory

Locations

219 N Highway 52
Ste R
Moncks Corner, SC 29461
Phone (843) 761-3325

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1902177520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 N HIGHWAY 52",
            "address_2": "STE R",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613926",
            "telephone_number": "843-761-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 N HIGHWAY 52",
            "address_2": "STE R",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613926",
            "telephone_number": "843-761-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-13",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "VINSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-761-3325",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "4776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.