Provider Demographics
NPI:1780972687
Name:DENNIS, MICHAEL WARREN (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARREN
Last Name:DENNIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2124
Mailing Address - Country:US
Mailing Address - Phone:803-534-2328
Mailing Address - Fax:803-531-8419
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-534-2328
Practice Address - Fax:803-531-8419
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional