Healthcare Provider Details

I. General information

NPI: 1174767560
Provider Name (Legal Business Name): SUSAN OSBON SHEALEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ASHLEY TOWN CENTER DR
CHARLESTON SC
29414-5664
US

IV. Provider business mailing address

3030 ASHLEY TOWN CENTER DR
CHARLESTON SC
29414-5664
US

V. Phone/Fax

Practice location:
  • Phone: 843-735-5900
  • Fax: 843-735-7323
Mailing address:
  • Phone: 843-735-5900
  • Fax: 843-735-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5068
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5285
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: