Provider Demographics
NPI:1437241007
Name:SMITH, SUSAN ELAINE (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SUNSHINE CREST CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9734
Mailing Address - Country:US
Mailing Address - Phone:919-363-4822
Mailing Address - Fax:
Practice Address - Street 1:3716 NATIONAL DR
Practice Address - Street 2:SUITE 124
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4068
Practice Address - Country:US
Practice Address - Phone:919-783-8846
Practice Address - Fax:919-783-7305
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist