Provider Demographics
NPI:1871750364
Name:DAHL, GREGORY L (LPC, LPCS,CACII, NCC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:L
Last Name:DAHL
Suffix:
Gender:M
Credentials:LPC, LPCS,CACII, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 LADY ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3482
Mailing Address - Country:US
Mailing Address - Phone:803-622-0792
Mailing Address - Fax:803-451-7604
Practice Address - Street 1:1620 LADY ST STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3482
Practice Address - Country:US
Practice Address - Phone:803-622-0792
Practice Address - Fax:803-451-7604
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5374101YP2500X
SC1005205101YA0400X
SC5134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3000641104OtherWORKERS' COMP
SC322842Medicaid
SC3000641104OtherWORKERS' COMP