Provider Demographics
NPI:1710082391
Name:DAVIS, SUSAN ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MINE STREET
Mailing Address - Street 2:P.O.BOX 1556
Mailing Address - City:MCCORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835
Mailing Address - Country:US
Mailing Address - Phone:864-465-2412
Mailing Address - Fax:
Practice Address - Street 1:202 MINE STREET
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:864-465-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health