Provider Demographics
NPI: | 1467504514 |
---|---|
Name: | WHALEN, DOROTHY KARALEKAS (MSW) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | DOROTHY |
Middle Name: | KARALEKAS |
Last Name: | WHALEN |
Suffix: | |
Gender: | F |
Credentials: | MSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | GREENVILLE THERAPY CENTER |
Mailing Address - Street 2: | 3519 PELHAM ROAD SUITE 103 |
Mailing Address - City: | GREENVILLE |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29615 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-234-6778 |
Mailing Address - Fax: | 864-234-2474 |
Practice Address - Street 1: | GREENVILLE THERAPY CENTER |
Practice Address - Street 2: | 3519 PELHAM ROAD SUITE 103 |
Practice Address - City: | GREENVILLE |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29615 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-234-6778 |
Practice Address - Fax: | 864-234-2474 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-17 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | LISW CP SC#4710 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | Q32452 | Medicare ID - Type Unspecified | |
SC | 6193 | Medicare ID - Type Unspecified | GROUP |