Provider Demographics
NPI:1912042359
Name:DESHONG, D. VICTORIA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:D. VICTORIA
Middle Name:
Last Name:DESHONG
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4345
Mailing Address - Country:US
Mailing Address - Phone:843-856-0054
Mailing Address - Fax:843-856-4088
Practice Address - Street 1:212 SCOTT ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4345
Practice Address - Country:US
Practice Address - Phone:843-856-0054
Practice Address - Fax:843-856-4088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1905 AND 2475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health