Provider Demographics
NPI:1063835445
Name:COMMODORE, YVONNE ADASSA (EDD, EDS, LMSW)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:ADASSA
Last Name:COMMODORE
Suffix:
Gender:F
Credentials:EDD, EDS, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2196
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2196
Mailing Address - Country:US
Mailing Address - Phone:843-767-7624
Mailing Address - Fax:
Practice Address - Street 1:3614 ASHLEY PHOSPHATE RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8500
Practice Address - Country:US
Practice Address - Phone:843-767-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC188020101Y00000X, 101YM0800X, 104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool