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General NPI Number Information
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NPI Number | 1093887309
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Entity Type | Individual
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Provider Name | WILLIE BETHUNE LISW CP & AP
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 410 W LIBERTY ST #201
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City | SUMTER
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State | SC
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Zip | 29150-4865
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Country | US
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Telephone | 803-774-4377
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | SUMTER
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State | SC
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Zip | 29151-0464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 314
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License Number State | SC
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