MEDICARE: DAVID B ORVIN LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	7036	SC

General Provider Information

NPI Number	:	1700940814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B ORVIN LISW

Provider Business Mailing Address
First Line	:	222 W COLEMAN BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3588
Country	:	US
Telephone Number	:	843-406-8681
Fax Number	:	866-406-5031

Provider Business Practice Location Address
First Line	:	222 W COLEMAN BLVD
Second Line	:	SUITE 101
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3588
Country	:	US
Telephone Number	:	843-406-8681
Fax Number	:	866-406-5031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/23/2010

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Directions to “ DAVID B ORVIN LISW” Practice Location

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