MEDICARE: EVELYN DINGLE I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1497299853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN DINGLE I

Provider Business Mailing Address
First Line	:	2424 CITY HALL LN
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6538
Country	:	US
Telephone Number	:	843-789-6804
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 CITY HALL LN
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6538
Country	:	US
Telephone Number	:	843-789-6804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	02/24/2017

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Directions to “ EVELYN DINGLE I ” Practice Location

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