Provider Demographics
NPI:1497818942
Name:WINEGLASS, DORRAINE DINELL (MA)
Entity Type:Individual
Prefix:
First Name:DORRAINE
Middle Name:DINELL
Last Name:WINEGLASS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2432
Mailing Address - Country:US
Mailing Address - Phone:803-749-3589
Mailing Address - Fax:
Practice Address - Street 1:1037 US HWY 321 BYPASS
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health