Provider Demographics
NPI:1194960575
Name:HORTON, MARY ELIZABETH (LISW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HORTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 GARDNER RD
Mailing Address - Street 2:STE 1200
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5702
Mailing Address - Country:US
Mailing Address - Phone:843-224-6740
Mailing Address - Fax:843-572-5868
Practice Address - Street 1:1052 GARDNER RD STE 1200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5702
Practice Address - Country:US
Practice Address - Phone:843-224-6740
Practice Address - Fax:843-572-5868
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical