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NPI Code Detail

MEDICARE: MR. WILLIAM HENRY KORTHALS III MSW, LCSW

MEDICARE: MR. WILLIAM HENRY KORTHALS III MSW, LCSW
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
11041C0700XClinical Social WorkerQ1-0001104DE
21041C0700XClinical Social Worker061583NY
31041C0700XClinical Social Worker13050SC

General Provider Information

NPI Number : 1972721124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM HENRY KORTHALS III MSW, LCSW
Provider Business Mailing Address
First Line : 250 SOUTHERN BREEZES CIR
Second Line :
City : MURRELLS INLET
State : SC
Zip : 29576-9390
Country : US
Telephone Number : 716-517-1394
Fax Number :
Provider Business Practice Location Address
First Line : 1800 AIRPARK DR
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-1412
Country : US
Telephone Number : 843-301-3202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 03/21/2025

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