Healthcare Provider Details

I. General information

NPI: 1093373813
Provider Name (Legal Business Name): SUSAN LANG DBA A PLACE TO START
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 2ND AVE N STE 205
NORTH MYRTLE BEACH SC
29582-3288
US

IV. Provider business mailing address

1016 2ND AVE N STE 205
NORTH MYRTLE BEACH SC
29582-3288
US

V. Phone/Fax

Practice location:
  • Phone: 843-491-3344
  • Fax: 843-491-3399
Mailing address:
  • Phone: 843-491-3344
  • Fax: 843-491-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSAN LANG
Title or Position: OWNER
Credential: LISW-CP
Phone: 843-491-3344