Provider Demographics
NPI:1588989305
Name:MEDLEY, ROXIE C (LPC)
Entity type:Individual
Prefix:
First Name:ROXIE
Middle Name:C
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 HIGHWAY 11 W
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-9330
Mailing Address - Country:US
Mailing Address - Phone:864-581-2631
Mailing Address - Fax:864-602-6736
Practice Address - Street 1:2375 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1434
Practice Address - Country:US
Practice Address - Phone:864-581-2631
Practice Address - Fax:864-602-6736
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6400101YP2500X
101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121328Medicaid