Healthcare Provider Details

I. General information

NPI: 1710278312
Provider Name (Legal Business Name): MICHELLE MARIE HAMMOND-SUSTEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 02/17/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 HIGHLANDS HIGHWAY, SUITE 2
WALHALLA SC
29691-2969
US

IV. Provider business mailing address

1750 LAKE JEMIKI RD
WALHALLA SC
29691-4238
US

V. Phone/Fax

Practice location:
  • Phone: 678-467-9307
  • Fax:
Mailing address:
  • Phone: 678-467-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004374
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: