Provider Demographics
NPI:1366512790
Name:COX, DELORES GILMER (MED, LPC)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:GILMER
Last Name:COX
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 MOURNING DOVE DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7410
Mailing Address - Country:US
Mailing Address - Phone:843-449-3086
Mailing Address - Fax:843-449-5090
Practice Address - Street 1:1113 48TH AVE N
Practice Address - Street 2:SUITE 117
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5441
Practice Address - Country:US
Practice Address - Phone:843-449-3086
Practice Address - Fax:843-449-5090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional