Provider Demographics
NPI:1568541746
Name:MARKS, SUSAN TAYLOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TAYLOR
Last Name:MARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 MULLIGAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-4401
Mailing Address - Country:US
Mailing Address - Phone:828-593-7926
Mailing Address - Fax:828-627-8888
Practice Address - Street 1:124 LIFE WAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-6540
Practice Address - Country:US
Practice Address - Phone:828-627-5433
Practice Address - Fax:828-627-8888
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002595Medicaid
NC6002595Medicaid