Provider Demographics
NPI:1164106316
Name:DUPUIS, NORTHLYNN TY ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:NORTHLYNN
Middle Name:TY ROSE
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 KNOX ABBOTT DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4353
Mailing Address - Country:US
Mailing Address - Phone:843-501-1099
Mailing Address - Fax:
Practice Address - Street 1:440 KNOX ABBOTT DR STE 400
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4353
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional