Basic Information
| Provider Information | |||||||||
| NPI: | 1457884363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | DEE | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WARD | ||||||||
| OtherFirstName: | DELORES | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 910 COOK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291182124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035342328 | ||||||||
| FaxNumber: | 8035318419 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 COOK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291182124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035342328 | ||||||||
| FaxNumber: | 8035318419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 15120811 | SC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 10880 | SC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.