Provider Demographics
NPI:1891116380
Name:COTTER, SUZETTE (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALENCIA DR STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6313
Mailing Address - Country:US
Mailing Address - Phone:910-265-1894
Mailing Address - Fax:910-333-0671
Practice Address - Street 1:200 VALENCIA DR STE 130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6313
Practice Address - Country:US
Practice Address - Phone:910-265-1894
Practice Address - Fax:910-333-0671
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1676101YA0400X
NCC008365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)