Healthcare Provider Details

I. General information

NPI: 1194891127
Provider Name (Legal Business Name): DEBRA ANNE CARNOSSO LCSW-R AND LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA ANNE DOSS

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N KINGS HWY
MYRTLE BEACH SC
29577-3722
US

IV. Provider business mailing address

361 VINTAGE CIR
MYRTLE BEACH SC
29579-7132
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-4820
  • Fax: 843-448-9875
Mailing address:
  • Phone: 315-405-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10577
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075494
License Number StateNY

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: