Provider Demographics
NPI:1851516199
Name:SUSAN HURT, PH.D., CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:SUSAN HURT, PH.D., CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-633-8100
Mailing Address - Street 1:204 E FISHER ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4908
Mailing Address - Country:US
Mailing Address - Phone:704-633-8100
Mailing Address - Fax:704-209-4332
Practice Address - Street 1:204 E FISHER ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4908
Practice Address - Country:US
Practice Address - Phone:704-633-8100
Practice Address - Fax:704-209-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2928251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000772Medicaid