Provider Demographics
NPI:1396757191
Name:ESQUIBEL, SIMONE L (LISW-CP, MSW, JD)
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:L
Last Name:ESQUIBEL
Suffix:
Gender:F
Credentials:LISW-CP, MSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 MAIN ST # 178
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3030
Mailing Address - Country:US
Mailing Address - Phone:843-315-5112
Mailing Address - Fax:
Practice Address - Street 1:144 JUNIATA LOOP
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:25966
Practice Address - Country:US
Practice Address - Phone:843-315-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079461041C0700X
NMI-063261041C0700X
SC101231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1170Medicaid
NM36877573Medicaid