Provider Demographics
NPI:1699159160
Name:DANTZLER, DEIRDRE ELISA (LMSW)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ELISA
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6210
Mailing Address - Country:US
Mailing Address - Phone:843-379-2688
Mailing Address - Fax:843-379-2698
Practice Address - Street 1:14 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6210
Practice Address - Country:US
Practice Address - Phone:843-379-2688
Practice Address - Fax:843-379-2698
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker