Healthcare Provider Details

I. General information

NPI: 1043697642
Provider Name (Legal Business Name): STACY JOYE LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2015
Last Update Date: 05/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 JAMESTOWN DR SUITE 208B
MURRELLS INLET SC
29576-7507
US

IV. Provider business mailing address

654 BELLAMY AVE PO BOX 926
MURRELLS INLET SC
29576-3790
US

V. Phone/Fax

Practice location:
  • Phone: 843-344-0294
  • Fax:
Mailing address:
  • Phone: 843-344-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9121
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: