Healthcare Provider Details

I. General information

NPI: 1932110814
Provider Name (Legal Business Name): IRENE AVINGER SEADALE LPC LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE MULLINAX

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8799 OLD HIGHWAY #6
SANTEE SC
29461
US

IV. Provider business mailing address

8799 OLD HIGHWAY #6
SANTEE SC
29461
US

V. Phone/Fax

Practice location:
  • Phone: 803-854-4139
  • Fax: 803-854-9054
Mailing address:
  • Phone: 803-854-4139
  • Fax: 803-854-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0858PROFESSIONALCOUS
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3404SOCIALWORKER
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: