Provider Demographics
NPI:1639896897
Name:DIMARIA, SEAN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:DIMARIA
Suffix:
Gender:M
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 1:3305 PINE BELT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3126
Mailing Address - Country:US
Mailing Address - Phone:803-319-8407
Mailing Address - Fax:
Practice Address - Street 1:3305 PINE BELT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3126
Practice Address - Country:US
Practice Address - Phone:803-319-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC155291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical