Provider Demographics
NPI:1144594904
Name:YON, ADELINE P (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ADELINE
Middle Name:P
Last Name:YON
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 1:1512 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6077
Mailing Address - Country:US
Mailing Address - Phone:803-614-9285
Mailing Address - Fax:
Practice Address - Street 1:1512 AMELIA ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6077
Practice Address - Country:US
Practice Address - Phone:803-614-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNONEOtherAPPLYING FOR MEDICAID NUMBER