Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 82 | SC |
NPI | 1134324213 |
---|---|
Provider Name | Dr. Susan Anne Bennett |
First Address | Spartanburg, SC 29302-1281 |
Second Address | Spartanburg, SC 29302-1281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |