Most Relevant Information
Provider Data
| NPI Number: | 1003371956 |
| Provider Name: | BODEQUIA SIMON LMSW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/05/2019 |
| Last Updated: | 02/05/2019 |
Provider Practice Location
108 PALMETTO PARK BLVD STE D
LEXINGTON
SC
290727969
Practice Location Phone/Fax
| Phone: | 8039961500 |
| Fax: |
Provider Mailing Location
500 HARBISON BLVD APT 1315
COLUMBIA
SC
292121726
Provider Mailing Phone/Fax
| Phone: | 8034472401 |
| Fax: |