Provider Demographics
NPI:1598078537
Name:BELLINGER-SHIELDS, MARSHA A (LMSW)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:A
Last Name:BELLINGER-SHIELDS
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 1:295 CULLER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-5312
Mailing Address - Country:US
Mailing Address - Phone:803-387-1250
Mailing Address - Fax:
Practice Address - Street 1:144 ARUNDEL DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1664
Practice Address - Country:US
Practice Address - Phone:803-531-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC413093Medicaid