Provider Demographics
NPI:1154048023
Name:DAVID, DWANA LOUISE (LPES)
Entity type:Individual
Prefix:MS
First Name:DWANA
Middle Name:LOUISE
Last Name:DAVID
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3411
Mailing Address - Country:US
Mailing Address - Phone:843-617-5749
Mailing Address - Fax:
Practice Address - Street 1:2685 CELANESE RD STE 105
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2994
Practice Address - Country:US
Practice Address - Phone:803-661-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist