Provider Demographics
NPI:1447341953
Name:PRYOR, DAVID THOMAS JR (LCSW, LISW-CP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:PRYOR
Suffix:JR
Gender:M
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11947 GRANDHAVEN DR STE N
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7862
Mailing Address - Country:US
Mailing Address - Phone:843-894-0000
Mailing Address - Fax:843-589-9054
Practice Address - Street 1:11947 GRANDHAVEN DR STE N
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7862
Practice Address - Country:US
Practice Address - Phone:843-894-0000
Practice Address - Fax:843-589-9054
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006202A1041C0700X
OHI0007774SUPV104100000X
OHI00077741041C0700X
SC146321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR SW29921Medicare ID - Type Unspecified
M400037055Medicare UPIN