Provider Demographics
NPI:1982731691
Name:HUNTER, BEVERLY LESAINE
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:LESAINE
Last Name:HUNTER
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 1:7 WINDY KNL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9031
Mailing Address - Country:US
Mailing Address - Phone:803-996-1500
Mailing Address - Fax:
Practice Address - Street 1:204 PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7851
Practice Address - Country:US
Practice Address - Phone:803-996-1500
Practice Address - Fax:803-996-1511
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry