Provider Demographics
NPI:1760091664
Name:DAWKINS, TERANCE MILES (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:TERANCE
Middle Name:MILES
Last Name:DAWKINS
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 1:512 DRAGONFLY CT
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2779
Mailing Address - Country:US
Mailing Address - Phone:864-621-9148
Mailing Address - Fax:
Practice Address - Street 1:512 DRAGONFLY CT
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2779
Practice Address - Country:US
Practice Address - Phone:864-621-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC121481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical