Provider Demographics
NPI:1336480235
Name:ONEPPO, SUSAN C (FAMILY TRAINER)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:ONEPPO
Suffix:
Gender:F
Credentials:FAMILY TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 EDGELAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMOOR
Mailing Address - State:SC
Mailing Address - Zip Code:29712-7733
Mailing Address - Country:US
Mailing Address - Phone:803-789-5834
Mailing Address - Fax:
Practice Address - Street 1:101 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8411
Practice Address - Country:US
Practice Address - Phone:803-493-5158
Practice Address - Fax:803-896-8972
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003262345171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator