Provider Demographics
NPI:1144891664
Name:PAYNE, TIMOTHY CRAIG JR (LMSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:PAYNE
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 MICHIGAN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29404-5518
Mailing Address - Country:US
Mailing Address - Phone:843-804-0912
Mailing Address - Fax:
Practice Address - Street 1:4034 MICHIGAN AVE APT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29404-5518
Practice Address - Country:US
Practice Address - Phone:843-804-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker