Provider Demographics
NPI:1982772562
Name:SNOW, BERTHA P
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:P
Last Name:SNOW
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 1:114 SOUTHDOWN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-4266
Mailing Address - Country:US
Mailing Address - Phone:803-647-9164
Mailing Address - Fax:
Practice Address - Street 1:1073 US HWY 321 BYPASS SOUTH
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-4689
Practice Address - Fax:803-737-0126
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health