Healthcare Provider Details

I. General information

NPI: 1396757191
Provider Name (Legal Business Name): SIMONE L ESQUIBEL LISW-CP, MSW, JD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 11/02/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 JUNIATA LOOP
LITTLE RIVER SC
25966
US

IV. Provider business mailing address

730 MAIN ST # 178
NORTH MYRTLE BEACH SC
29582-3030
US

V. Phone/Fax

Practice location:
  • Phone: 843-315-5112
  • Fax:
Mailing address:
  • Phone: 843-315-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007946
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06326
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: