Provider Demographics
NPI:1407071996
Name:MCCACHREN, SUSAN CAMPBELL
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAMPBELL
Last Name:MCCACHREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FURMAN RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5049
Mailing Address - Country:US
Mailing Address - Phone:828-262-9100
Mailing Address - Fax:828-262-4157
Practice Address - Street 1:155 FURMAN RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5049
Practice Address - Country:US
Practice Address - Phone:828-262-9100
Practice Address - Fax:828-262-4157
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001258104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07630OtherBCBS PASSAGES
NC07630OtherBCBS PASSAGES