Provider Demographics
NPI:1417462193
Name:BOWERS, SUSAN DALE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DALE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7545
Mailing Address - Country:US
Mailing Address - Phone:252-455-9725
Mailing Address - Fax:
Practice Address - Street 1:3800 FABER PLACE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8532
Practice Address - Country:US
Practice Address - Phone:252-455-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health