Provider Demographics
NPI:1346024684
Name:BIVINS, WILLIAM JR (LSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BIVINS
Suffix:JR
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 KARIKAL DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4067
Mailing Address - Country:US
Mailing Address - Phone:850-896-1329
Mailing Address - Fax:
Practice Address - Street 1:3528 KARIKAL DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4067
Practice Address - Country:US
Practice Address - Phone:850-896-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309780104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker