Provider Demographics
NPI:1346437399
Name:COLAVITO, SUSAN C
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:COLAVITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, MFT
Mailing Address - Street 1:197 NEUSE WINDS DR
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-9130
Mailing Address - Country:US
Mailing Address - Phone:252-249-1775
Mailing Address - Fax:
Practice Address - Street 1:506 NORTH STREET
Practice Address - Street 2:
Practice Address - City:ORIENTAL
Practice Address - State:NC
Practice Address - Zip Code:28571-9130
Practice Address - Country:US
Practice Address - Phone:252-675-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC766101YP2500X
NC743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist