Healthcare Provider Details

I. General information

NPI: 1518914878
Provider Name (Legal Business Name): VICTORIA CAREY MSW, LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date: 06/18/2010
Reactivation Date: 04/16/2020

III. Provider practice location address

727 PEPPERBUSH DR
MYRTLE BEACH SC
29579-4163
US

IV. Provider business mailing address

727 PEPPERBUSH DR
MYRTLE BEACH SC
29579-4163
US

V. Phone/Fax

Practice location:
  • Phone: 843-333-1363
  • Fax: 864-448-1448
Mailing address:
  • Phone: 843-333-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007304
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: