Provider Demographics
NPI:1760695472
Name:SQUIRES, SUSAN HUNTER (LPC LICENSED PROFESS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HUNTER
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ANDREA DRIVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282
Mailing Address - Country:US
Mailing Address - Phone:336-854-5344
Mailing Address - Fax:336-476-1479
Practice Address - Street 1:3954 NORTH NC HWY 109
Practice Address - Street 2:LEDFORD MIDDLE SCHOOL SCHOOL COUNSELOR
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360
Practice Address - Country:US
Practice Address - Phone:336-476-4816
Practice Address - Fax:336-476-1479
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5351101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional