Provider Demographics
NPI:1881718393
Name:MCCLURE, SUSAN MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BEN SAWYER BLVD
Mailing Address - Street 2:#15
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5500
Mailing Address - Country:US
Mailing Address - Phone:843-216-7646
Mailing Address - Fax:
Practice Address - Street 1:192 E BAY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2123
Practice Address - Country:US
Practice Address - Phone:843-722-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical