Provider Demographics
NPI:1154649986
Name:OSMENT, CAROL JANE (MA, MDIV,)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JANE
Last Name:OSMENT
Suffix:
Gender:F
Credentials:MA, MDIV,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-3122
Mailing Address - Country:US
Mailing Address - Phone:843-877-2502
Mailing Address - Fax:
Practice Address - Street 1:901 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3722
Practice Address - Country:US
Practice Address - Phone:843-448-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral