Provider Demographics
NPI:1588776629
Name:SPEACH, BETTY J (LMSW)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:SPEACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4081
Mailing Address - Country:US
Mailing Address - Phone:864-229-7120
Mailing Address - Fax:
Practice Address - Street 1:202 HIGHWAY 28 N
Practice Address - Street 2:
Practice Address - City:MC CORMICK
Practice Address - State:SC
Practice Address - Zip Code:29899-0001
Practice Address - Country:US
Practice Address - Phone:864-465-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid
SC3340Medicare ID - Type Unspecified