Provider Demographics
NPI:1043017072
Name:MIKELL, SAVANNAH E (MS, LPCA)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:E
Last Name:MIKELL
Suffix:
Gender:
Credentials:MS, LPCA
Other - Prefix:MS
Other - First Name:SAVANNAH
Other - Middle Name:E
Other - Last Name:MAULDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4325 DICK POND RD STE E
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6810
Mailing Address - Country:US
Mailing Address - Phone:843-900-7641
Mailing Address - Fax:
Practice Address - Street 1:4325 DICK POND RD STE E
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6810
Practice Address - Country:US
Practice Address - Phone:843-900-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCOU.10299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health