Provider Demographics
NPI:1588424683
Name:LAKE, CASEY SCOTT (LPCA)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:SCOTT
Last Name:LAKE
Suffix:
Gender:M
Credentials:LPCA
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Mailing Address - Street 1:CASEY@GOODVIBESTHERAPYCENTER.COM
Mailing Address - Street 2:141 MCDONALD COURT MYRTLE BEACH SC 29588
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-294-0646
Mailing Address - Fax:843-294-0318
Practice Address - Street 1:CASEY@GOODVIBESTHERAPYCENTER.COM
Practice Address - Street 2:141 MCDONALD COURT MYRTLE BEACH SC 29588
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:843-294-0646
Practice Address - Fax:843-294-0318
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
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Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health