Provider Demographics
NPI:1225063332
Name:FROST, SUSAN ANNE (MA MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE
Last Name:FROST
Suffix:
Gender:F
Credentials:MA MA LPC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ANNE
Other - Last Name:KLANDERMAN FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 TACOMA CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1625
Mailing Address - Country:US
Mailing Address - Phone:828-257-2759
Mailing Address - Fax:828-252-8436
Practice Address - Street 1:125 TACOMA CIR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1625
Practice Address - Country:US
Practice Address - Phone:828-257-2759
Practice Address - Fax:828-252-8436
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
138KYOtherBCBS
NC6102254Medicaid