Healthcare Provider Details

I. General information

NPI: 1982312724
Provider Name (Legal Business Name): SUSAN GAIL ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CENTRAL PARK LN
SENECA SC
29678-1156
US

IV. Provider business mailing address

10 FINANCIAL BLVD
ANDERSON SC
29621-1770
US

V. Phone/Fax

Practice location:
  • Phone: 864-844-9432
  • Fax: 864-844-9430
Mailing address:
  • Phone: 864-844-9432
  • Fax: 864-844-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC008010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: