Provider Demographics
NPI:1487721460
Name:UNDERWOOD, MARY WELBORN (MSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WELBORN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-9157
Mailing Address - Country:US
Mailing Address - Phone:864-599-9912
Mailing Address - Fax:
Practice Address - Street 1:601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2105
Practice Address - Country:US
Practice Address - Phone:864-597-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical