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General NPI Number Information
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NPI Number | 1841270212
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Entity Type | Individual
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Provider Name | JACK WILSON RHYNE LCSW, LISW
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 812 STATE RD
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City | CHERAW
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State | SC
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Zip | 29520
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Country | US
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Telephone | 843-537-0961
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Fax | 843-537-0908
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | HARTSVILLE
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State | SC
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Zip | 29551-1090
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Country | US
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Telephone | 843-857-0111
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Fax | 843-857-0206
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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 | C002180
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004880
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License Number State | SC
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