Healthcare Provider Details

I. General information

NPI: 1104810233
Provider Name (Legal Business Name): WILLIAM R QUIRK CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WESTERN LN SUITE A
IRMO SC
29063-7953
US

IV. Provider business mailing address

PO BOX 3086
IRMO SC
29063-4011
US

V. Phone/Fax

Practice location:
  • Phone: 803-397-7521
  • Fax: 803-667-4963
Mailing address:
  • Phone: 803-397-7521
  • Fax: 803-667-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4957
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: