Graceful Tides Counseling Service LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

GRACEFUL TIDES COUNSELING SERVICE LLC

Practice address

1297 Professional Dr Ste 102
Myrtle Beach, SC 29577-5713

Phone

(843) 284-3255

NPI assigned

Oct 20, 2021

Organization subpart

No

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

Authorized official

Name

Stacy Maloney, MA LPCANPI 1942943535

Title

Owner Therapist

Phone

(843) 284-3255

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

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

• Stacy D Maloney, LPC

  • Counselor
  • Myrtle Beach, SC
  • NPI 1942943535
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1982367645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1297 PROFESSIONAL DR STE 102",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775713",
            "telephone_number": "843-284-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1297 PROFESSIONAL DR STE 102",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775713",
            "telephone_number": "843-284-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL TIDES COUNSELING SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "MALONEY",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OWNER THERAPIST",
        "authorized_official_telephone_number": "843-284-3255",
        "authorized_official_credential": "MA LPCA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "smaloney@gracefultidescounseling.net",
            "affiliation": "N",
            "address_1": "1297 Professional Dr Ste 102",
            "city": "Myrtle Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295775713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kay Goring, M.D.
• Brian Thomas Gorman, DO
• Elizabeth Ann Gowdy, PHD, LISW-CP, MSW
• Michelle Gowen, MS
• Paola Goyeneche, LPC
• Lauri B. Graham, O.D.
• Jodi Dee Grainger, FNP
• Grand Strand Dermatology
• Grand Strand Family and Esthetic Dentistry
• Grand Strand Family and Esthetic Dentistry

• Mental Health Counselor in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.