Provider Demographics
NPI:1740348382
Name:EHRLICH, SUSAN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1637
Mailing Address - Country:US
Mailing Address - Phone:919-539-8333
Mailing Address - Fax:919-784-0250
Practice Address - Street 1:5613 DURALEIGH RD
Practice Address - Street 2:SUITE 161
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:919-784-0508
Practice Address - Fax:919-784-0250
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0024321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC002432OtherLCSW STATE LICENSE
NC129W4OtherBCBS PROVIDER NUMBER
NC6106539Medicaid
NC129W4OtherBCBS PROVIDER NUMBER