Provider Demographics
NPI:1639980329
Name:DUMONT, MINDY (LPCA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:DUMONT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GRADUATE LN
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-5240
Mailing Address - Country:US
Mailing Address - Phone:843-670-6620
Mailing Address - Fax:
Practice Address - Street 1:597 OLD MOUNT HOLLY RD STE 307
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2834
Practice Address - Country:US
Practice Address - Phone:843-879-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health