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General NPI Number Information
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NPI Number | 1881718393
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Entity Type | Individual
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Provider Name | SUSAN MARY MCCLURE PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 192 E BAY ST SUITE 203
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City | CHARLESTON
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State | SC
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Zip | 29401-2123
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Country | US
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Telephone | 843-722-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 BEN SAWYER BLVD #15
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-5500
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Country | US
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Telephone | 843-216-7646
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 348
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License Number State | SC
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