Healthcare Provider Details

I. General information

NPI: 1952851347
Provider Name (Legal Business Name): SHANDI MOVSKY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DRIVE
CONWAY SC
29526
US

IV. Provider business mailing address

164 WACCAMAW MEDICAL PARK DRIVE WACCAMAW CENTER FOR MENTAL HEALTH
CONWAY SC
29526
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11387
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: