Healthcare Provider Details

I. General information

NPI: 1689277923
Provider Name (Legal Business Name): CAREY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

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: 843-564-2063
  • 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 Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierSW1691
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: MS. VICTORIA CAREY
Title or Position: PROPRIETOR
Credential: LISW-CP
Phone: 843-333-1363