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General NPI Number Information
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NPI Number | 1023105681
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Entity Type | Individual
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Provider Name | SUSANNA MARY VARGHESE L.P.C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 2609 SEMINOLE RD
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City | COLUMBIA
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State | SC
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Zip | 29210-6581
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Country | US
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Telephone | 803-752-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 CLEMSON RD UNIT 291311
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City | COLUMBIA
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State | SC
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Zip | 29229-0553
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Country | US
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Telephone | 803-752-0828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4873
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License Number State | SC
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