Provider Demographics
NPI:1902172992
Name:LUDINGTON, DEAN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:LUDINGTON
Suffix:
Gender:M
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 1:1108 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3704
Mailing Address - Country:US
Mailing Address - Phone:207-467-0481
Mailing Address - Fax:
Practice Address - Street 1:1108 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3704
Practice Address - Country:US
Practice Address - Phone:207-467-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker