Individual
DR. CHARLES WILLIAM BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401001279
MI
1041C0700X
Clinical Social Worker
6801010401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401001279
PROFESSIONAL COUNSELOR LI
MI
01
—
6801010401
MASTER SOCIAL WORKER LICE
MI
Enumeration date
11/30/2006
Last updated
04/22/2008
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