Individual
MS. LISA J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWR, LISW-CP
Contact information
Practice address
901 N KINGS HWY, MYRTLE BEACH, SC 29577-3722
(843) 448-4820
(843) 448-9875
Mailing address
974 PERIWINKLE PL, MYRTLE BEACH, SC 29577-5269
(843) 712-1979
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9875
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
618200
MVP MOHAWK VALLEY PLAN
NY
Enumeration date
08/29/2006
Last updated
03/22/2017
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