Provider Demographics
NPI:1003172487
Name:DOWD, SUSAN L (MSW, LCAS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:DOWD
Suffix:
Gender:F
Credentials:MSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 BELLA PARK TRL
Mailing Address - Street 2:APT 418
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7096
Mailing Address - Country:US
Mailing Address - Phone:919-798-3419
Mailing Address - Fax:
Practice Address - Street 1:4021 BELLA PARK TRL APT 418
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7584
Practice Address - Country:US
Practice Address - Phone:919-798-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1964101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)