Healthcare Provider Details

I. General information

NPI: 1437961786
Provider Name (Legal Business Name): ANDREA JO HENRY DSW, MSW, LISW-CP/S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BRANDYMILL BLVD
MYRTLE BEACH SC
29588-7226
US

IV. Provider business mailing address

298 BRANDYMILL BLVD
MYRTLE BEACH SC
29588-7226
US

V. Phone/Fax

Practice location:
  • Phone: 843-685-2302
  • Fax:
Mailing address:
  • Phone: 843-685-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13945
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022218
License Number StatePA

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: