Healthcare Provider Details

I. General information

NPI: 1689849770
Provider Name (Legal Business Name): LORI LEGRAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
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:
Mailing address:
  • Phone: 843-945-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073276-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12404
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: