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NPI Code Detail

MEDICARE: MS. NANCY ANN BETTIS M.DIV. CACI

MEDICARE: MS. NANCY ANN BETTIS M.DIV. CACI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1211143SC

General Provider Information

NPI Number : 1154751121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY ANN BETTIS M.DIV. CACI
Provider Business Mailing Address
First Line : 1068 S LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29073-3720
Country : US
Telephone Number : 803-726-9311
Fax Number : 803-726-9403
Provider Business Practice Location Address
First Line : 1068 S LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29073-3720
Country : US
Telephone Number : 803-726-9311
Fax Number : 803-726-9403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2013
Last Update Date : 11/12/2013

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