Provider Demographics
NPI:1669768750
Name:BYRD, KEVIN BRADFORD (LISW-CP, MAC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BRADFORD
Last Name:BYRD
Suffix:
Gender:M
Credentials:LISW-CP, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 1/2 CALHOUN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-451-7600
Mailing Address - Fax:803-451-7604
Practice Address - Street 1:1403 1/2 CALHOUN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-451-7600
Practice Address - Fax:803-451-7604
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9378101YA0400X, 1041C0700X
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1425Medicaid