Healthcare Provider Details

I. General information

NPI: 1538072475
Provider Name (Legal Business Name): SUZANNE DAVIGNON LAC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 E MAIN ST
ROCK HILL SC
29730-5948
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 803-526-7666
  • Fax: 803-526-7648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCS-20098
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number536
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAADC-1805254
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number807
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14434
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: