Provider Demographics
NPI:1407529597
Name:NEELY-GOODWIN, SHEBBY ANANIE (LMSW)
Entity Type:Individual
Prefix:DR
First Name:SHEBBY
Middle Name:ANANIE
Last Name:NEELY-GOODWIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 FORT LINDLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-6634
Mailing Address - Country:US
Mailing Address - Phone:803-412-2823
Mailing Address - Fax:
Practice Address - Street 1:346 FORT LINDLEY RD
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-6634
Practice Address - Country:US
Practice Address - Phone:803-412-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC3401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty