Healthcare Provider Details

I. General information

NPI: 1174341499
Provider Name (Legal Business Name): SUSAN JOYNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 WILLIAMS RD
PIEDMONT SC
29673-7914
US

IV. Provider business mailing address

PO BOX 438
SAN MATEO CA
94401-0438
US

V. Phone/Fax

Practice location:
  • Phone: 650-539-8507
  • Fax:
Mailing address:
  • Phone: 650-539-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN JOYNER
Title or Position: OWNER
Credential: LCSW, LCSW-C
Phone: 650-539-8507