Provider Demographics
NPI:1467651828
Name:NOVELLO, SUSAN GAIL (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:NOVELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 BONHAM AVE
Mailing Address - Street 2:APT.1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4259
Mailing Address - Country:US
Mailing Address - Phone:910-465-9447
Mailing Address - Fax:910-799-5747
Practice Address - Street 1:942 BONHAM AVE
Practice Address - Street 2:APT.1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4259
Practice Address - Country:US
Practice Address - Phone:910-465-9447
Practice Address - Fax:910-799-5747
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103036Medicaid
NC141AJOtherBLUE CROSS AND BLUE SHIEL