Healthcare Provider Details

I. General information

NPI: 1447341953
Provider Name (Legal Business Name): DAVID THOMAS PRYOR JR. LCSW, LISW-CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11947 GRANDHAVEN DR STE N
MURRELLS INLET SC
29576-7862
US

IV. Provider business mailing address

11947 GRANDHAVEN DR STE N
MURRELLS INLET SC
29576-7862
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-0000
  • Fax: 843-589-9054
Mailing address:
  • Phone: 843-894-0000
  • Fax: 843-589-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006202A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0007774SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0007774
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14632
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: