Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1104228865 |
---|---|
Provider Name | Joe Bethea JR. |
First Address | Marion, SC 29571-2328 |
Second Address | Marion, SC 29571-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |