Active NPI
Joel Allyn Southerlin II, LISW-CP
- Social Worker
- Columbia, SC
National Provider Identifier
1710294152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- T5508
- Practice address
- 3420 Pine Belt Rd
Columbia, SC 29204-3129 - Phone
- (803) 691-9861
- NPI assigned
- Sep 7, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | T5508 | SC | Primary |
Addresses
Primary practice location
3420 Pine Belt Rd
Columbia, SC 29204-3129
Mailing address
3420 Pine Belt Rd
Columbia, SC 29204-3129
Phone (803) 691-9861
Other names 1
- Mr. Joel Allyn Southerlin II
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T5508 | SC | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523923200000",
"number": "1710294152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3420 PINE BELT RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292043129",
"telephone_number": "803-691-9861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3420 PINE BELT RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292043129",
"telephone_number": "803-691-9861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERLIN",
"first_name": "JOEL",
"middle_name": "ALLYN",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "LISW-CP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-07",
"last_updated": "2018-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "T5508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOEL",
"last_name": "SOUTHERLIN",
"middle_name": "ALLYN",
"prefix": "MR.",
"suffix": "II",
"credential": "LISW-CP",
"code": "2",
"type": "Professional Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.