Healthcare Provider Details

I. General information

NPI: 1720289689
Provider Name (Legal Business Name): DEBORAH W JOSEPH LISW-CP AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 GREENMORE DR
CHARLESTON SC
29407-3530
US

IV. Provider business mailing address

1829 GREENMORE DR
CHARLESTON SC
29407-3530
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0930
  • Fax: 843-571-6314
Mailing address:
  • Phone: 843-327-6569
  • Fax: 843-571-6314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2165
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2165
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: