Provider Demographics
NPI:1932110814
Name:SEADALE, IRENE AVINGER (LPC LMSW)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:AVINGER
Last Name:SEADALE
Suffix:
Gender:F
Credentials:LPC LMSW
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:MULLINAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8799 OLD HIGHWAY #6
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:803-854-4139
Mailing Address - Fax:803-854-9054
Practice Address - Street 1:8799 OLD HIGHWAY #6
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:803-854-4139
Practice Address - Fax:803-854-9054
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0858PROFESSIONALCOUS101Y00000X
SC3404SOCIALWORKER104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker