Provider Demographics
NPI:1942396122
Name:LEE, SUSAN SPICER (LCSW LPC CCAS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SPICER
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW LPC CCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 WORCASTER PLACE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-366-2382
Mailing Address - Fax:704-362-1029
Practice Address - Street 1:1232 WORCASTER PLACE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-366-2382
Practice Address - Fax:704-362-1029
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137101YA0400X
NC2017101YP2500X
NCC0028931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2869588Medicare ID - Type Unspecified