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General NPI Number Information
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NPI Number | 1891752846
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Entity Type | Individual
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Provider Name | SUSAN CAROLE GENTRY LISW-CP, CSC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 23 SURREY CT
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City | COLUMBIA
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State | SC
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Zip | 29212-3139
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Country | US
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Telephone | 803-551-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SURREY CT
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City | COLUMBIA
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State | SC
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Zip | 29212-3139
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Country | US
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Telephone | 803-551-2900
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6196
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License Number State | SC
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