Individual
MS. SUSAN H BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
125 FORREST ST, FORT MILL, SC 29715-2341
(803) 579-1559
Mailing address
PO BOX 746, FORT MILL, SC 29716-0746
(803) 579-1559
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8752
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570629234
TAX ID
—
Enumeration date
12/20/2007
Last updated
02/15/2017
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