Provider Demographics
NPI:1285715920
Name:BULSZA, SUSAN M (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:BULSZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50046
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-333-6767
Mailing Address - Fax:843-448-9875
Practice Address - Street 1:2513 N. OAK ST.
Practice Address - Street 2:SUITE 208
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-333-6767
Practice Address - Fax:843-448-9875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4956101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1089Medicaid