Provider Demographics
NPI:1114951761
Name:MEYER, SUSAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MEYER
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 1:214 E IVYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-5401
Mailing Address - Country:US
Mailing Address - Phone:910-326-2644
Mailing Address - Fax:
Practice Address - Street 1:CAPE CARTERET WELLNESS CENTER
Practice Address - Street 2:300 TAYLOR NORTON RD
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28539
Practice Address - Country:US
Practice Address - Phone:910-265-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102933Medicaid