Healthcare Provider Details

I. General information

NPI: 1144035049
Provider Name (Legal Business Name): MAXINE DEUTSCHENDORF LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 MILLWOOD AVE
COLUMBIA SC
29205-1221
US

IV. Provider business mailing address

2744 MILLWOOD AVE
COLUMBIA SC
29205-1221
US

V. Phone/Fax

Practice location:
  • Phone: 803-960-1550
  • Fax:
Mailing address:
  • Phone: 803-960-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10573
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: