Provider Demographics
NPI:1184156291
Name:HOUSTON, MARCY EDEN (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:EDEN
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2442
Mailing Address - Country:US
Mailing Address - Phone:843-325-2223
Mailing Address - Fax:
Practice Address - Street 1:1001 PARIS AVE
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2442
Practice Address - Country:US
Practice Address - Phone:843-325-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI202101YM0800X
SC5387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health