Provider Demographics
NPI:1568162998
Name:OWEN, SUSAN ALLISON (LISW-CP, LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALLISON
Last Name:OWEN
Suffix:
Gender:F
Credentials:LISW-CP, LCSW, CEAP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:OWEN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CEAP
Mailing Address - Street 1:620 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:EDISTO ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29438-3611
Mailing Address - Country:US
Mailing Address - Phone:434-420-2910
Mailing Address - Fax:
Practice Address - Street 1:620 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:EDISTO ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29438-3611
Practice Address - Country:US
Practice Address - Phone:434-420-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040051691041C0700X
SC130551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical