Provider Demographics
NPI:1962982066
Name:GOUVIN, MARCHELLE DAWN (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:MARCHELLE
Middle Name:DAWN
Last Name:GOUVIN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SUNCHASER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7307
Mailing Address - Country:US
Mailing Address - Phone:803-238-8613
Mailing Address - Fax:803-376-4099
Practice Address - Street 1:224 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3546
Practice Address - Country:US
Practice Address - Phone:803-808-5222
Practice Address - Fax:803-957-2062
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0064191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical