Healthcare Provider Details

I. General information

NPI: 1982017596
Provider Name (Legal Business Name): RONALD MILFORD SPRUILL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

109 BEE ST
CHARLESTON SC
29401-5703
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7076
  • Fax: 843-789-6297
Mailing address:
  • Phone: 843-789-7076
  • Fax: 843-789-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7762
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: