Provider Demographics
NPI:1144004367
Name:BASKIN, DEDRA (LPC-A; EDD)
Entity type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:LPC-A; EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 REVERE CIR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-1628
Mailing Address - Country:US
Mailing Address - Phone:803-424-5242
Mailing Address - Fax:
Practice Address - Street 1:405 REVERE CIR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-1628
Practice Address - Country:US
Practice Address - Phone:803-424-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional