Provider Demographics
NPI:1467051953
Name:WINCHESTER, DEONTAY ADRAIN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DEONTAY
Middle Name:ADRAIN
Last Name:WINCHESTER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 ETON ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6711
Mailing Address - Country:US
Mailing Address - Phone:843-202-5789
Mailing Address - Fax:
Practice Address - Street 1:500 S KAMINSKI ST STE 213
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3435
Practice Address - Country:US
Practice Address - Phone:843-932-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13807104100000X, 101Y00000X, 101YA0400X, 101YP2500X, 102L00000X, 102X00000X, 1041C0700X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist