Healthcare Provider Details

I. General information

NPI: 1174018378
Provider Name (Legal Business Name): SUSAN CAMBERLYN REEP BS, CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN CAMBERLYN REEP BS, CACP

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 MALL DR UNIT CD
NORTH CHARLESTON SC
29406-6514
US

IV. Provider business mailing address

2470 MALL DR UNIT CD
NORTH CHARLESTON SC
29406-6514
US

V. Phone/Fax

Practice location:
  • Phone: 843-207-4721
  • Fax: 843-207-4727
Mailing address:
  • Phone: 843-207-4721
  • Fax: 843-207-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: