Provider Demographics
NPI:1053022749
Name:MCELVEEN, ANISSA (LMT, BA, MLD)
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:MCELVEEN
Suffix:
Gender:F
Credentials:LMT, BA, MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 PENN CIR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5841
Mailing Address - Country:US
Mailing Address - Phone:843-307-6539
Mailing Address - Fax:
Practice Address - Street 1:123 W HOME AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4123
Practice Address - Country:US
Practice Address - Phone:843-287-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist