MEDICARE: SUSAN CPX

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407054190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CPX

Provider Business Mailing Address
First Line	:	500 N MAIN ST
Second Line	:	SUITE4
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-871-4790
Fax Number	:	843-871-8579

Provider Business Practice Location Address
First Line	:	500 N MAIN ST
Second Line	:	SUITE4
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-871-4790
Fax Number	:	843-871-8579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/09/2007

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Directions to “ SUSAN CPX ” Practice Location

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