Individual
DAVID MICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA SOCIAL WORKER
Contact information
Practice address
1375 GILWAY EXTENSION, HOLLY HILL, SC 29059
(803) 496-3410
(803) 496-9185
Mailing address
2319 ST MATTHEWS ROAD, ORANGEBURG, SC 29118
(803) 536-1571
(803) 536-1463
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413093
—
SC
Enumeration date
07/10/2006
Last updated
07/08/2007
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