Provider Demographics
NPI:1518629559
Name:HART, BETHANY MARIE (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 PUTNAM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7256
Mailing Address - Country:US
Mailing Address - Phone:828-244-9136
Mailing Address - Fax:
Practice Address - Street 1:400 FLEMINGTON DR.
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450-1932
Practice Address - Country:US
Practice Address - Phone:910-646-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0168231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical