Provider Demographics
NPI:1922477983
Name:RAUSHER, DIANNE TOLENTINO (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:TOLENTINO
Last Name:RAUSHER
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 1:774 S SHELMORE BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7625
Mailing Address - Country:US
Mailing Address - Phone:843-936-2566
Mailing Address - Fax:
Practice Address - Street 1:774 S SHELMORE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7625
Practice Address - Country:US
Practice Address - Phone:843-936-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical