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General NPI Number Information
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NPI Number | 1760923551
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Entity Type | Organization
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Legal Business Name | SUSAN H. BULLARD, LISW-CP, LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 1624 EBENEZER RD
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City | ROCK HILL
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State | SC
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Zip | 29732-1809
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Country | US
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Telephone | 803-599-8869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746
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City | FORT MILL
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State | SC
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Zip | 29716-0746
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Country | US
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Telephone | 803-599-8869
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | SUSAN H BULLARD
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Credential | LISW-CP
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Telephone | 803-599-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8752
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License Number State | SC
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