Provider Demographics
NPI:1154751121
Name:BETTIS, NANCY ANN (MDIV CACI)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:BETTIS
Suffix:
Gender:F
Credentials:MDIV CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-3720
Mailing Address - Country:US
Mailing Address - Phone:803-726-9311
Mailing Address - Fax:803-726-9403
Practice Address - Street 1:1068 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-3720
Practice Address - Country:US
Practice Address - Phone:803-726-9311
Practice Address - Fax:803-726-9403
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1211143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)