Provider Demographics
NPI:1487667846
Name:VORE, SUSAN BROWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BROWN
Last Name:VORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 S DYE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1001
Mailing Address - Country:US
Mailing Address - Phone:810-732-6030
Mailing Address - Fax:810-732-0551
Practice Address - Street 1:3095 S DYE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1001
Practice Address - Country:US
Practice Address - Phone:810-732-6030
Practice Address - Fax:810-732-0551
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001720103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN2980002Medicare ID - Type Unspecified