Healthcare Provider Details

I. General information

NPI: 1972721124
Provider Name (Legal Business Name): WILLIAM HENRY KORTHALS III MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 AIRPARK DR
MYRTLE BEACH SC
29577-1412
US

IV. Provider business mailing address

250 SOUTHERN BREEZES CIR
MURRELLS INLET SC
29576-9390
US

V. Phone/Fax

Practice location:
  • Phone: 843-301-3202
  • Fax:
Mailing address:
  • Phone: 716-517-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001104
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number061583
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13050
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: