Healthcare Provider Details

I. General information

NPI: 1023604600
Provider Name (Legal Business Name): LAURA L CRAWFORD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

IV. Provider business mailing address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-1452
  • Fax: 843-945-1489
Mailing address:
  • Phone: 843-945-1452
  • Fax: 843-945-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: