Provider Demographics
NPI:1053844910
Name:DEMPSEY, COLLEEN POLCZYNSKI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:POLCZYNSKI
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N CEDAR ST STE D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6433
Mailing Address - Country:US
Mailing Address - Phone:843-832-4265
Mailing Address - Fax:
Practice Address - Street 1:300 N CEDAR ST STE D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6433
Practice Address - Country:US
Practice Address - Phone:843-832-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker