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General NPI Number Information
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NPI Number | 1528498094
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Entity Type | Individual
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Provider Name | LAURA HETRICK LISW-CP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 214 FOX HUNT PL
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City | GALIVANTS FERRY
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State | SC
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Zip | 29544-8072
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Country | US
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Telephone | 843-798-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 310 AZALEA AVE
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City | MARION
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State | SC
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Zip | 29571-8042
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Country | US
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Telephone | 843-798-3555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16854
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2405539
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 16854
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License Number State | SC
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