Provider Demographics
NPI:1144200924
Name:SHEALY, SUE E (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:E
Last Name:SHEALY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BIRCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8801
Mailing Address - Country:US
Mailing Address - Phone:843-763-9005
Mailing Address - Fax:843-763-9005
Practice Address - Street 1:7 GAMECOCK AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3379
Practice Address - Country:US
Practice Address - Phone:843-763-9005
Practice Address - Fax:843-763-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0197Medicaid
SC1064724Medicare UPIN
SC052319000Medicare UPIN
SC6254430Medicare UPIN
SCQM0197Medicaid