Provider Demographics
NPI:1477910198
Name:SMITH, SUSAN (LPCA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S GREEN ST
Mailing Address - Street 2:SUITE300
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3517
Mailing Address - Country:US
Mailing Address - Phone:828-437-3000
Mailing Address - Fax:828-433-1026
Practice Address - Street 1:617 S GREEN ST
Practice Address - Street 2:SUITE300
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3517
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:828-433-1026
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA12106OtherLICENSE