Healthcare Provider Details

I. General information

NPI: 1962685164
Provider Name (Legal Business Name): IVAN JERMAINE BELIN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COMMERCE AVE
CHESTERFIELD SC
29709-0471
US

IV. Provider business mailing address

PO BOX 471 207 COMMERCE AVE
CHESTERFIELD SC
29709-0471
US

V. Phone/Fax

Practice location:
  • Phone: 843-623-2229
  • Fax: 843-623-2559
Mailing address:
  • Phone: 843-623-2229
  • Fax: 843-623-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: