Provider Demographics
NPI:1033575691
Name:BROWN, BETHANIE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7511 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2894
Practice Address - Country:US
Practice Address - Phone:803-767-4463
Practice Address - Fax:803-250-2706
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical