Provider Demographics
NPI:1467551416
Name:TYO, LUCINDA (LISW)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:TYO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1941
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-1941
Mailing Address - Country:US
Mailing Address - Phone:843-278-2275
Mailing Address - Fax:
Practice Address - Street 1:148 OLD COURSE RD.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-6215
Practice Address - Country:US
Practice Address - Phone:843-478-8962
Practice Address - Fax:843-636-7429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1041C0700X1041C0700X
SC69191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical