Individual
MRS. SUZAN ALLEN WATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
430 CRYSTAL LAKE DR, CHAPIN, SC 29036-9514
(803) 240-5460
Mailing address
430 CRYSTAL LAKE DR, CHAPIN, SC 29036-9514
(803) 240-5460
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2482
SC
101YP2500X
Professional Counselor
1976
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3335
MEDICARE
SC
05
—
421504
—
SC
Enumeration date
10/06/2006
Last updated
08/01/2021
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