Provider Demographics
NPI:1356124770
Name:DEAN, KATHLEEN M (LISW-CP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
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 1:207 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-1007
Mailing Address - Country:US
Mailing Address - Phone:803-718-6209
Mailing Address - Fax:
Practice Address - Street 1:207 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1007
Practice Address - Country:US
Practice Address - Phone:803-718-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC162691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical