Provider Demographics
NPI:1063670008
Name:LUND, SUSANNA GRAY (MS)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:GRAY
Last Name:LUND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:SUSANNA
Other - Middle Name:ELLEN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:507 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6246
Mailing Address - Country:US
Mailing Address - Phone:336-408-8103
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPICE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5766
Practice Address - Country:US
Practice Address - Phone:336-768-3972
Practice Address - Fax:336-331-1361
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional