Provider Demographics
NPI:1699911503
Name:HUISMAN, SHIRLEY J (LISW)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:J
Last Name:HUISMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:J
Other - Last Name:HUISMAN JEZOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 OLD CHEROKEE RD
Mailing Address - Street 2:#203
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6971
Mailing Address - Country:US
Mailing Address - Phone:803-667-1783
Mailing Address - Fax:
Practice Address - Street 1:458 OLD CHEROKEE RD
Practice Address - Street 2:#203
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6971
Practice Address - Country:US
Practice Address - Phone:803-667-1783
Practice Address - Fax:803-359-6265
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC73901041C0700X
SC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical