Provider Demographics
NPI:1942205513
Name:BETHANY, DAVID C (MED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:BETHANY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7428
Mailing Address - Country:US
Mailing Address - Phone:843-442-4341
Mailing Address - Fax:
Practice Address - Street 1:1004 ANNA KNAPP BLVD
Practice Address - Street 2:STE 2
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3134
Practice Address - Country:US
Practice Address - Phone:843-442-4341
Practice Address - Fax:843-881-9317
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1632101YP2500X
SC2712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional