Provider Demographics
NPI:1609949643
Name:TAHAN, SUSAN L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:TAHAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 DUTCH ELM DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4199
Mailing Address - Country:US
Mailing Address - Phone:919-303-2972
Mailing Address - Fax:
Practice Address - Street 1:5305 DUTCH ELM DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-4199
Practice Address - Country:US
Practice Address - Phone:919-303-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCC0059251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health