Provider Demographics
NPI:1962755355
Name:CROUSE, MICHAEL JANE (LISW-CP, CACP)
Entity type:Individual
Prefix:MS
First Name:MICHAEL
Middle Name:JANE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:LISW-CP, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 STARBOARD TACK DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676-4035
Mailing Address - Country:US
Mailing Address - Phone:864-280-3402
Mailing Address - Fax:
Practice Address - Street 1:691 S OAK ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3827
Practice Address - Country:US
Practice Address - Phone:864-882-7563
Practice Address - Fax:864-882-7388
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical