Provider Demographics
NPI:1790303923
Name:KRAUS, SUSAN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KRAUS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 ALGONQUIN DR.
Mailing Address - Street 2:963-H
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:239-450-2294
Mailing Address - Fax:843-692-1409
Practice Address - Street 1:1032 ALGONQUIN DR.
Practice Address - Street 2:963-H
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:239-450-2294
Practice Address - Fax:843-692-1409
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC11519101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor