Organization
ACTING OUT LOUD THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTA PAYNE PSYD-LPC, CAGCS (OWNER/CLINICIAN)
(818) 442-9055
Entity
Organization
Contact information
Practice address
1156 BOWMAN RD UNIT 207, MT PLEASANT, SC 29464-3858
(818) 442-9055
Mailing address
1050 JOHNNIE DODDS BLVD UNIT 1283, MT PLEASANT, SC 29465-2862
(818) 442-9055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC2334
—
SC
Enumeration date
07/23/2024
Last updated
07/23/2024
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