Provider Demographics
NPI:1740493881
Name:CECIL, SUSANNAH SHARPE (LPC)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:SHARPE
Last Name:CECIL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 WHITMORE COVE LN
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8882
Mailing Address - Country:US
Mailing Address - Phone:336-201-7929
Mailing Address - Fax:
Practice Address - Street 1:8140 WHITMORE COVE LN
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8882
Practice Address - Country:US
Practice Address - Phone:336-201-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional