Provider Demographics
NPI:1962615625
Name:WEST, SUSAN MARIA LORETO (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN MARIA
Middle Name:LORETO
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SEVEN FARMS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8001
Mailing Address - Country:US
Mailing Address - Phone:843-278-5402
Mailing Address - Fax:843-278-5403
Practice Address - Street 1:295 SEVEN FARMS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8001
Practice Address - Country:US
Practice Address - Phone:843-278-5402
Practice Address - Fax:843-278-5403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC963103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling