Provider Demographics
NPI:1356846877
Name:BURNSIDE, CADYN LIAM (LISW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:CADYN
Middle Name:LIAM
Last Name:BURNSIDE
Suffix:
Gender:M
Credentials:LISW, LISW-CP
Other - Prefix:
Other - First Name:C.
Other - Middle Name:LIAM
Other - Last Name:BURNSIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW, LISW-CP
Mailing Address - Street 1:205 FERNBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2966
Mailing Address - Country:US
Mailing Address - Phone:712-790-0688
Mailing Address - Fax:
Practice Address - Street 1:10 EAST AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2202
Practice Address - Country:US
Practice Address - Phone:864-743-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC141101041C0700X
IA0889391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical