Healthcare Provider Details

I. General information

NPI: 1861256877
Provider Name (Legal Business Name): DR SUSAN HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 ARBUTUS DR
COLUMBIA SC
29205-2104
US

IV. Provider business mailing address

832 ARBUTUS DR
COLUMBIA SC
29205-2104
US

V. Phone/Fax

Practice location:
  • Phone: 808-651-4860
  • Fax:
Mailing address:
  • Phone: 808-651-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN LUCILLE HALL
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 808-651-4860