Provider Demographics
NPI:1093764987
Name:BYNUM, C JIM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:C JIM
Middle Name:
Last Name:BYNUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HWY 87
Mailing Address - Street 2:UNIT G
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2831
Mailing Address - Country:US
Mailing Address - Phone:910-494-8746
Mailing Address - Fax:
Practice Address - Street 1:1900 HWY 87,
Practice Address - Street 2:UNIT G
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2831
Practice Address - Country:US
Practice Address - Phone:850-710-3702
Practice Address - Fax:850-710-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046111041C0700X
FLSW00026521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL327479Medicare PIN