Provider Demographics
NPI:1730352956
Name:MILLER-DUPRE, LYSA ANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LYSA
Middle Name:ANNE
Last Name:MILLER-DUPRE
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 1:1615 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-791-1511
Mailing Address - Fax:803-791-1572
Practice Address - Street 1:1615 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-791-1511
Practice Address - Fax:803-791-1572
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker