Provider Demographics
NPI:1699831503
Name:SHOEMAKER, SUSAN ROSS (LPC-S, NCC, ACS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ROSS
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:LPC-S, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N ELM ST
Mailing Address - Street 2:#801
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2083
Mailing Address - Country:US
Mailing Address - Phone:336-790-1119
Mailing Address - Fax:336-274-1236
Practice Address - Street 1:301 N ELM ST
Practice Address - Street 2:#801
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2083
Practice Address - Country:US
Practice Address - Phone:336-790-1119
Practice Address - Fax:336-274-1236
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102521Medicaid