Individual
MISS MELIZA MANGCO FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, LPC
Contact information
Practice address
418 STEPHANIE DR, GOOSE CREEK, SC 29445-3542
(843) 425-4109
Mailing address
418 STEPHANIE DR, GOOSE CREEK, SC 29445-3542
(843) 425-4109
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
4849
SC
106H00000X
Marriage & Family Therapist
Primary
4501
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
423976
MHN PROVIDER NUMBER (PIN)
—
Enumeration date
09/22/2008
Last updated
09/24/2008
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