Healthcare Provider Details

I. General information

NPI: 1700395704
Provider Name (Legal Business Name): LATRICIA HARVEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8903
US

IV. Provider business mailing address

9528 MYERS LN
MYRTLE BEACH SC
29588-7482
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5060
  • Fax: 843-347-3959
Mailing address:
  • Phone: 347-520-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11236
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: