Healthcare Provider Details

I. General information

NPI: 1609583582
Provider Name (Legal Business Name): BETHANY DAVIS BLIZARD LCSW, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WALKER ST
COLUMBUS NC
28722-9433
US

IV. Provider business mailing address

220 5TH AVE E
HENDERSONVILLE NC
28792-4377
US

V. Phone/Fax

Practice location:
  • Phone: 828-894-2222
  • Fax: 828-894-2229
Mailing address:
  • Phone: 828-692-4289
  • Fax: 828-696-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-30641
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: