MEDICARE: SUSAN LANG DBA A PLACE TO START

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093373813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN LANG DBA A PLACE TO START

Provider Business Mailing Address
First Line	:	1016 2ND AVE N STE 205
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-491-3344
Fax Number	:	843-491-3399

Provider Business Practice Location Address
First Line	:	1016 2ND AVE N STE 205
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-491-3344
Fax Number	:	843-491-3399

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN LANG
Credential	:	LISW-CP
Telephone Number	:	843-491-3344

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/13/2023

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Directions to “SUSAN LANG DBA A PLACE TO START ” Practice Location

Language	Start Address	Practice Location

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