Provider Demographics
NPI:1225335169
Name:JONES, SUSAN KELLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KELLEY
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:PARK
Other - Last Name:STYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1213 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-9203
Mailing Address - Country:US
Mailing Address - Phone:843-697-1573
Mailing Address - Fax:
Practice Address - Street 1:105 CENTRAL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-697-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical