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NPI Code Detail

MEDICARE: SUSAN CAROL BAISDEN M.S.; PH.D.

MEDICARE: SUSAN CAROL BAISDEN M.S.; PH.D.
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
1101YM0800XMental Health Counselor538WV
2103TC0700XClinical Psychologist403WV
31041C0700XClinical Social WorkerCP00452669WV

Other Identifiers

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

General Provider Information

NPI Number : 1558361527
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN CAROL BAISDEN M.S.; PH.D.
Provider Business Mailing Address
First Line : 41 W 5TH AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3201
Country : US
Telephone Number : 304-235-3390
Fax Number : 304-235-3391
Provider Business Practice Location Address
First Line : 41 W 5TH AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3201
Country : US
Telephone Number : 304-235-3390
Fax Number : 304-235-3391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 03/04/2024

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