Healthcare Provider Details

I. General information

NPI: 1407849805
Provider Name (Legal Business Name): BARBARA DEASE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

IV. Provider business mailing address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax: 803-774-4627
Mailing address:
  • Phone: 803-774-4500
  • Fax: 803-774-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1876
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: