Provider Demographics
NPI:1720227937
Name:DEAN, PATRICIA A (MED)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:DEAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:618 16TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2222
Mailing Address - Country:US
Mailing Address - Phone:843-263-2614
Mailing Address - Fax:877-275-4815
Practice Address - Street 1:618 16TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2222
Practice Address - Country:US
Practice Address - Phone:843-263-2614
Practice Address - Fax:877-275-4815
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional