Provider Demographics
NPI:1710294152
Name:SOUTHERLIN, JOEL ALLYN II (LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ALLYN
Last Name:SOUTHERLIN
Suffix:II
Gender:M
Credentials:LISW-CP
Other - Prefix:MR
Other - First Name:JOEL
Other - Middle Name:ALLYN
Other - Last Name:SOUTHERLIN
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:3420 PINE BELT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3129
Mailing Address - Country:US
Mailing Address - Phone:803-691-9861
Mailing Address - Fax:
Practice Address - Street 1:3420 PINE BELT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3129
Practice Address - Country:US
Practice Address - Phone:803-691-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCT5508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker