Provider Demographics
NPI:1538459920
Name:CARMICHAEL, DOROTHEA (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WENLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8358
Mailing Address - Country:US
Mailing Address - Phone:803-394-7900
Mailing Address - Fax:
Practice Address - Street 1:130 WENLOCK CIR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8358
Practice Address - Country:US
Practice Address - Phone:803-394-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health