Provider Demographics
NPI:1083019913
Name:BETHEL, SAMUEL (MSW, LCSW, LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:BETHEL
Suffix:
Gender:M
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6863
Mailing Address - Country:US
Mailing Address - Phone:270-543-8988
Mailing Address - Fax:
Practice Address - Street 1:7 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6863
Practice Address - Country:US
Practice Address - Phone:270-543-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130354021041C0700X
SC126191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical