Healthcare Provider Details

I. General information

NPI: 1689444770
Provider Name (Legal Business Name): MRS. CHARLENE CARMICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 11TH AVE
LAKEVIEW SC
29563
US

IV. Provider business mailing address

PO BOX 923
DILLON SC
29536-0923
US

V. Phone/Fax

Practice location:
  • Phone: 843-250-3530
  • Fax: 843-268-1046
Mailing address:
  • Phone: 980-242-0748
  • Fax: 843-268-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: