Provider Demographics
NPI:1962685164
Name:BELIN, IVAN JERMAINE (MA)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:JERMAINE
Last Name:BELIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:207 COMMERCE AVE
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-0471
Mailing Address - Country:US
Mailing Address - Phone:843-623-2229
Mailing Address - Fax:843-623-2559
Practice Address - Street 1:207 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-0471
Practice Address - Country:US
Practice Address - Phone:843-623-2229
Practice Address - Fax:843-623-2559
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC405127Medicaid