=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396757191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMONE L ESQUIBEL LISW-CP, MSW, JD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 11/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 JUNIATA LOOP
-----------------------------------------------------
City | LITTLE RIVER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 25966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-315-5112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 730 MAIN ST # 178
-----------------------------------------------------
City | NORTH MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29582-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-315-5112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C007946
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I-06326
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10123
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------