Individual
WILLIE BETHUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW CP & AP
Contact information
Practice address
410 W LIBERTY ST, #201, SUMTER, SC 29150-4865
(803) 774-4377
Mailing address
PO BOX 464, SUMTER, SC 29151-0464
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
314
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4365
—
SC
Enumeration date
11/14/2006
Last updated
07/08/2007
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