Basic Information
| Provider Information | |||||||||
| NPI: | 1033689682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORBES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 HANAHAN PLANTATION CIRCLE | ||||||||
| Address2: | |||||||||
| City: | HANAHAN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2100 CHARLIE HALL BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438524100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 11840 | SC | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 11840 | SC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 14980 | SC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.