Provider Demographics
NPI:1154470888
Name:CAIN, SUSAN WATSON (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WATSON
Last Name:CAIN
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 1:1606 WELLINGTON AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7747
Mailing Address - Country:US
Mailing Address - Phone:910-799-4505
Mailing Address - Fax:910-799-4345
Practice Address - Street 1:1606 WELLINGTON AVE
Practice Address - Street 2:UNIT C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7747
Practice Address - Country:US
Practice Address - Phone:910-799-4505
Practice Address - Fax:910-799-4345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health