Healthcare Provider Details

I. General information

NPI: 1184348575
Provider Name (Legal Business Name): SUSAN HELEN TOTH LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 BALMORE DR
MYRTLE BEACH SC
29579-3353
US

IV. Provider business mailing address

1041 BALMORE DR
MYRTLE BEACH SC
29579-3353
US

V. Phone/Fax

Practice location:
  • Phone: 803-309-8670
  • Fax:
Mailing address:
  • Phone: 803-309-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9445
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: