Provider Demographics
NPI:1720531858
Name:PROVOST, MEGAN YEARY (MA, LPC, CAC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:YEARY
Last Name:PROVOST
Suffix:
Gender:F
Credentials:MA, LPC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 MEETING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3146
Mailing Address - Country:US
Mailing Address - Phone:864-354-0963
Mailing Address - Fax:
Practice Address - Street 1:763 MEETING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3146
Practice Address - Country:US
Practice Address - Phone:864-354-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional