Provider Demographics
NPI:1023551728
Name:MANDEL, DANA BROOKE (MA, LPC-I, CACP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BROOKE
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MA, LPC-I, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2629
Mailing Address - Country:US
Mailing Address - Phone:843-719-3000
Mailing Address - Fax:
Practice Address - Street 1:306 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2629
Practice Address - Country:US
Practice Address - Phone:843-719-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional