Provider Demographics
NPI:1770649329
Name:MILLER, SUSAN STOTT (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:STOTT
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8611
Mailing Address - Country:US
Mailing Address - Phone:919-553-1317
Mailing Address - Fax:
Practice Address - Street 1:308 W MILLBROOK RD STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4374
Practice Address - Country:US
Practice Address - Phone:919-848-2100
Practice Address - Fax:919-849-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional