Healthcare Provider Details

I. General information

NPI: 1700940814
Provider Name (Legal Business Name): DAVID B ORVIN LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W COLEMAN BLVD SUITE 101
MOUNT PLEASANT SC
29464-3588
US

IV. Provider business mailing address

222 W COLEMAN BLVD
MOUNT PLEASANT SC
29464-3588
US

V. Phone/Fax

Practice location:
  • Phone: 843-406-8681
  • Fax: 866-406-5031
Mailing address:
  • Phone: 843-406-8681
  • Fax: 866-406-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7036
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: