Provider Demographics
NPI:1376636928
Name:CHAPPELL, SUSAN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2367
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2367
Mailing Address - Country:US
Mailing Address - Phone:252-335-0803
Mailing Address - Fax:252-335-9143
Practice Address - Street 1:305 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4425
Practice Address - Country:US
Practice Address - Phone:252-335-0803
Practice Address - Fax:252-335-9143
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003405Medicaid
NC1278FOtherBC/BS
NC1278FOtherBCBS
NC1278FOtherBCBS