Provider Demographics
NPI:1235288622
Name:KAM, SUSAN BETH (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:KAM
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:WALTON
Other - Last Name:KAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:673 COVINGTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-1893
Mailing Address - Country:US
Mailing Address - Phone:910-287-6962
Mailing Address - Fax:
Practice Address - Street 1:63 STAMP ACT DRIVE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422
Practice Address - Country:US
Practice Address - Phone:910-253-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPA#3133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist