Provider Demographics
NPI:1669847273
Name:BYRD, CARMELITA
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BURDETTE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1003
Mailing Address - Country:US
Mailing Address - Phone:864-596-8491
Mailing Address - Fax:864-596-8495
Practice Address - Street 1:175 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1003
Practice Address - Country:US
Practice Address - Phone:864-594-8491
Practice Address - Fax:864-596-8495
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239677101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool