Provider Demographics
NPI:1922289909
Name:RAUTON, DYAN FORE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:FORE
Last Name:RAUTON
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 1:1851 DAWSON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5702
Mailing Address - Country:US
Mailing Address - Phone:843-851-1806
Mailing Address - Fax:
Practice Address - Street 1:1851 DAWSON BRANCH RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5702
Practice Address - Country:US
Practice Address - Phone:843-851-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical