| Graceful Tides Counseling Service Llc | |
|
1297 Professional Dr Ste 102 Myrtle Beach SC 29577-5713 | |
| (843) 284-3255 | |
| Not Available |
| Full Name | Graceful Tides Counseling Service Llc |
|---|---|
| Speciality | Counselor |
| Location | 1297 Professional Dr Ste 102, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Stacy Maloney (OWNER THERAPIST) |
| Authorized Official Contact | 8432843255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceful Tides Counseling Service Llc 1297 Professional Dr Ste 102 Myrtle Beach SC 29577-5713 Ph: (843) 284-3255 | Graceful Tides Counseling Service Llc 1297 Professional Dr Ste 102 Myrtle Beach SC 29577-5713 Ph: (843) 284-3255 |
| NPI Number | 1982367645 |
|---|---|
| Provider Enumeration Date | 10/20/2021 |
| Last Update Date | 10/20/2021 |
| Certification Date | 10/20/2021 |
| Medicare PECOS PAC ID | 7719326156 |
|---|---|
| Medicare Enrollment ID | O20240417002551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982367645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stacy D Maloney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942943535 PECOS PAC ID: 8628417060 Enrollment ID: I20240417002678 |
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