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General NPI Number Information
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NPI Number | 1518247394
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Entity Type | Individual
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Provider Name | SUSAN KAYE CRISP LPC
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Gender | Female
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 4303 LIVE OAK DR
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City | LITTLE RIVER
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State | SC
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Zip | 29566-9138
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Country | US
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Telephone | 843-663-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | LITTLE RIVER
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State | SC
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Zip | 29566-0547
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Country | US
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Telephone | 843-663-8000
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Fax | 843-663-8166
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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 | 7799
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008164
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 43287
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License Number State | NC
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