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General NPI Number Information
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NPI Number | 1164106316
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Entity Type | Individual
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Provider Name | NORTHLYNN TY ROSE DUPUIS LPC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 440 KNOX ABBOTT DR STE 400
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City | CAYCE
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State | SC
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Zip | 29033-4353
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Country | US
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Telephone | 843-501-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 440 KNOX ABBOTT DR STE 400
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City | CAYCE
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State | SC
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Zip | 29033-4353
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Country | US
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Telephone | 843-501-1099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | R10876
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8954
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License Number State | SC
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