Healthcare Provider Details

I. General information

NPI: 1912560095
Provider Name (Legal Business Name): STEPHEN FRANCIS KOVACS III LISW-CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 AIRPARK DR
MYRTLE BEACH SC
29577-1412
US

IV. Provider business mailing address

1800 AIRPARK DR
MYRTLE BEACH SC
29577-1412
US

V. Phone/Fax

Practice location:
  • Phone: 843-477-0177
  • Fax:
Mailing address:
  • Phone: 843-347-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14805
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015584
License Number StateNC

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: