Provider Demographics
NPI:1891002747
Name:HALLIDAY, MARY BETH (LISW-CP)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:HALLIDAY
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 1:103 SAGO PALM CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5565
Mailing Address - Country:US
Mailing Address - Phone:724-301-2928
Mailing Address - Fax:
Practice Address - Street 1:103 SAGO PALM CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5565
Practice Address - Country:US
Practice Address - Phone:724-301-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC175951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical