Provider Demographics
NPI:1902240351
Name:BALDWIN, MARY SUSANNAH (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSANNAH
Last Name:BALDWIN
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 1:25 WOODS LAKE RD STE 712
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2765
Mailing Address - Country:US
Mailing Address - Phone:864-242-0005
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD STE 712
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2765
Practice Address - Country:US
Practice Address - Phone:864-242-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional