Provider Demographics
NPI:1265484141
Name:OXENDINE, MARY ALICE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:OXENDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N MAGNOLIA ST
Mailing Address - Street 2:SWCMHC
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1946
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:525 N LAFAYETTE DR.
Practice Address - Street 2:SWCMHC/IPS CAROLINA PLACE
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29151-1946
Practice Address - Country:US
Practice Address - Phone:803-775-6293
Practice Address - Fax:803-775-7593
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health