Provider Demographics
NPI:1063419158
Name:MACPHERSON, T DIANNE (LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:T DIANNE
Middle Name:
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:REIDVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29375-0084
Mailing Address - Country:US
Mailing Address - Phone:828-585-5021
Mailing Address - Fax:828-687-6882
Practice Address - Street 1:3150 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5904
Practice Address - Country:US
Practice Address - Phone:864-662-9666
Practice Address - Fax:828-687-6882
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS 3328101YA0400X
NCLCAS-23423101YA0400X
NCC0082261041C0700X
SC103391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71239Medicare ID - Type Unspecified