Provider Demographics
NPI:1194693671
Name:WILLARD, MIRANDA FRANCES (LISW-CP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:FRANCES
Last Name:WILLARD
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 CHEVIOT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5204
Mailing Address - Country:US
Mailing Address - Phone:205-643-5294
Mailing Address - Fax:
Practice Address - Street 1:4317 CHEVIOT DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5204
Practice Address - Country:US
Practice Address - Phone:205-643-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty