Provider Demographics
NPI:1811269178
Name:MARCINO, JEFF (LPC-I, PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:MARCINO
Suffix:
Gender:M
Credentials:LPC-I, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 WANDO PARK BLVD SUITE #104
Mailing Address - Street 2:
Mailing Address - City:MT.PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-330-2336
Mailing Address - Fax:
Practice Address - Street 1:474 WANDO PARK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7933
Practice Address - Country:US
Practice Address - Phone:843-330-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical