Individual
SUSAN A STAUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
886 JOHNNIE DODDS BLVD, MT. PLEASANT, SC 29464
(843) 367-1210
Mailing address
886 JOHNNIE DODDS BLVD, MT PLEASANT, SC 29464-3190
(843) 367-1210
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LISW 3421
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LISW 3421
STATE LICENSE FOR MSW
SC
Enumeration date
05/15/2007
Last updated
07/08/2007
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